Contract Pharmacy Details

COSTCO WHOLESALE
DSH120006 CASTLE MEDICAL CENTER dba ADVENTIST HEALTH CASTLE

Covered Entity Details

Entity Name

CASTLE MEDICAL CENTER dba ADVENTIST HEALTH CASTLE

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH120006

Entity Address

640 ULUKAHIKI STREET
KAILUA, HI 96734

Medicare Provider Number

120006

Participating Start Date

4/1/2006

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

COSTCO WHOLESALE

Pharmacy Address

DBA: COSTCO PHARMACY #687
525 ALA KAWA ST
HONOLULU, HI 96817

Pharmacy Comments

Contract Details

Approval Date

4/8/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2015
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Wendi Barber, VP Finance / CFO
(808) 263-5142

Contract Pharmacy Representative

Christopher Pierce, AVP Pharmacy Benefits
(425) 427-7986

Signed By Date

4/8/2013

340B Drug Pricing Program Database