Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CAH121301-00 KAU HOSPITAL

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

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

7/15/2021

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

Signed By Date

7/15/2021

340B Drug Pricing Program Database