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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH0925370 Ko'olauloa Health Center
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Covered Entity Details
Entity Name
Ko'olauloa Health Center
Subdivision Name
Kahuku Clinic
Type
HRSA-Funded Health Center
340B ID
CH0925370
Entity Address
56-119 Pualalea St
Kahuku, HI 96731-2052
Grant Number
H80CS06641
Participating Start Date
4/1/2006
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA LONGS DRUGS # 10153
54-316 KAMEHAMEHA HWY STE 102
HAUULA, HI 96717-9539
Pharmacy Comments
Contract Details
Approval Date
4/3/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TERRENCE ARATANI, CHIEF EXECUTIVE OFFICER
(808) 792-3840
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/3/2023
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