Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH120005 HILO MEDICAL CENTER

Covered Entity Details

Entity Name

HILO MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH120005

Entity Address

1190 WAIANUENUE AVENUE
HILO, HI 96720-2020

Medicare Provider Number

120005

Participating Start Date

4/1/2004

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

LONGS DRUGS # 17599
391 E MAKAALA ST
HILO, HI 96720

Pharmacy Comments

Contract Details

Approval Date

1/21/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/31/2025
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Dan Brinkman, CEO
(808) 932-3101

Contract Pharmacy Representative

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

Signed By Date

1/21/2021

340B Drug Pricing Program Database