Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
RRC120022-00 STRAUB CLINIC & HOSPITAL

Covered Entity Details

Entity Name

STRAUB CLINIC & HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC120022-00

Entity Address

888 S. KING STREET
HONOLULU, HI 96813

Medicare Provider Number

120022

Participating Start Date

1/1/2024

Last Recertification Date

8/21/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: LONGS DRUGS # 03040
1748 LILIHA ST.
HONOLULU, HI 96817

Pharmacy Comments

Contract Details

Approval Date

10/25/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/7/2023
Pharmacy closed

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

10/13/2023

340B Drug Pricing Program Database