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HAWAII PACIFIC HEALTH SPECIALTY PHARMACY
PED123300-00 KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN
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Covered Entity Details
Entity Name
KAPIOLANI MEDICAL CENTER FOR WOMEN & CHILDREN
Subdivision Name
Type
Children's Hospital
340B ID
PED123300-00
Entity Address
1319 PUNAHOU STREET
HONOLULU, HI 96826
Medicare Provider Number
123300
Participating Start Date
8/6/2010
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
HAWAII PACIFIC HEALTH SPECIALTY PHARMACY
Pharmacy Address
3375 KOAPAKA STREET
STE H400
HONOLULU, HI 96819
Pharmacy Comments
Contract Details
Approval Date
4/7/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David E Stumbaugh, VP, Supply Chain Management and Pharmacy
(808) 522-6946
Contract Pharmacy Representative
Hawaii Pacific Health
Shannon Terayama, Director, Outpatient & Ambulatory Pharmacy Services
(808) 404-8259
Signed By Date
4/7/2023
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