Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH120022 STRAUB CLINIC & HOSPITAL

Covered Entity Details

Entity Name

STRAUB CLINIC & HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH120022

Entity Address

888 S. KING STREET
HONOLULU, HI 96813

Medicare Provider Number

120022

Participating Start Date

4/1/2025

Last Recertification Date

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: LONGS DRUGS # 09259
94-060 FARRINGTON HWY #6
WAIPAHU, HI 96797

Pharmacy Comments

Contract Details

Approval Date

4/26/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946

Contract Pharmacy Representative

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

Signed By Date

4/15/2021

340B Drug Pricing Program Database