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LONGS DRUG STORES CALIFORNIA, L.L.C.
DSH120022 STRAUB CLINIC & HOSPITAL
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Covered Entity Details
Entity Name
STRAUB CLINIC & HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH120022
Entity Address
888 S. KING STREET
HONOLULU, HI 96813
Medicare Provider Number
120022
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA LONGS DRUGS # 10621
2155 KALAKAUA AVE
SUITE 102
HONOLULU, HI 96815
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2022
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