Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
RRC120022-00 STRAUB CLINIC & HOSPITAL

Covered Entity Details

Entity Name

STRAUB CLINIC & HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC120022-00

Entity Address

888 S. KING STREET
HONOLULU, HI 96813

Medicare Provider Number

120022

Participating Start Date

1/1/2024

Last Recertification Date

8/21/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: LONGS DRUGS # 09182
1088 BISHOP ST, STE 113
HONOLULU, HI 96813

Pharmacy Comments

Contract Details

Approval Date

10/21/2020

Contract Begin Date

11/3/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

MARTHA SMITH, Executive Vice President, Oahu Operations
(808) 522-2520

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/14/2020

340B Drug Pricing Program Database