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LONGS DRUG STORES CALIFORNIA, L.L.C.
CAH121304-00 KAHUKU MEDICAL CENTER
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Covered Entity Details
Entity Name
KAHUKU MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH121304-00
Entity Address
56-117 PUALALEA ST.
KAHUKU, HI 96731
Medicare Provider Number
121304
Participating Start Date
1/1/2018
Last Recertification Date
8/14/2024
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
4/21/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alan MacPhee, CEO
(808) 293-6222
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/21/2023
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