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WAL-MART PHARMACY 10-3478
DSH120022 STRAUB CLINIC & HOSPITAL
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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
WAL-MART PHARMACY 10-3478
Pharmacy Address
700 KEEAUMOKU STREET
HONOLULU (C), HI 96814
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
11/24/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
4/15/2021
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