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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09341C KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
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Covered Entity Details
Entity Name
KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES
Subdivision Name
KKV Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH09341C
Entity Address
2229 N School St
Honolulu, HI 96819-2588
Grant Number
H80CS00776
Participating Start Date
10/1/2014
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 09275
850 KAMEHAMEHA HWY STE 107
PEARL CITY, HI 96782
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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