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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09604A COMMUNITY CLINIC OF MAUI, INC.
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Covered Entity Details
Entity Name
COMMUNITY CLINIC OF MAUI, INC.
Subdivision Name
Community Clinic of Maui KHAO Satellite Clinic
Type
HRSA-Funded Health Center
340B ID
CH09604A
Entity Address
670A WAIALE ROAD
WAILUKU, HI 96793-2339
Grant Number
H80CS00722
Participating Start Date
4/1/2004
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 09303
1215 SOUTH KIHEI RD., SUITE B
KIHEI, HI 96753
Pharmacy Comments
Contract Details
Approval Date
10/14/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Vaz, Chief Executive Officer
(808) 872-1052
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2023
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