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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH093410 KOKUA KALIHI VALLEY COMPREHENSVIE FAMILY SERVICES
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Covered Entity Details
Entity Name
KOKUA KALIHI VALLEY COMPREHENSVIE FAMILY SERVICES
Subdivision Name
KOKUA KALIHI VALLEY MAIN CLINIC
Type
HRSA-Funded Health Center
340B ID
CH093410
Entity Address
2239 North School Street
HONOLULU, HI 96819
Grant Number
H80CS00776
Participating Start Date
7/1/1995
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 09228
1330 PALI HWY
HONOLULU, HI 96813
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID DERAUF, Executive Director
(808) 791-9415
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2022
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