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CAREMARK, L.L.C.
CAH121301-00 KAU HOSPITAL
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Covered Entity Details
Entity Name
KAU HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH121301-00
Entity Address
1 KAMANI STREET
PAHALA, HI 96777
Medicare Provider Number
121301
Participating Start Date
4/1/2021
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
CAREMARK, L.L.C.
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
7251 S. EASTERN AVE.
LAS VEGAS, NV 89119
Pharmacy Comments
Contract Details
Approval Date
7/13/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Brinkman, CEO
(808) 932-3101
Contract Pharmacy Representative
CVS Pharmacies
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
7/13/2021
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