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WALGREEN OF MAUI INC.
CH096040 COMMUNITY CLINIC OF MAUI
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Covered Entity Details
Entity Name
COMMUNITY CLINIC OF MAUI
Subdivision Name
Community Clinic of Maui
Type
HRSA-Funded Health Center
340B ID
CH096040
Entity Address
1881 Nani St
Wailuku, HI 96793-1811
Grant Number
H80CS00722
Participating Start Date
4/1/2004
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
WALGREEN OF MAUI INC.
Pharmacy Address
DBA WALGREENS #15115
700 WAIALE RD
WAILUKU, HI 96793
Pharmacy Comments
Contract Details
Approval Date
10/21/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DANA ALONZO-HOWETH, EXECUTIVE DIRECTOR
(808) 872-4027
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/21/2014
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