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COSTCO WHOLESALE
DSH120006 CASTLE MEDICAL CENTER dba ADVENTIST HEALTH CASTLE
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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
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