Contract Pharmacy Details

5 MINUTE PHARMACY LTC LLC
RWII968131 Community Health Outreach Work to Prevent AIDS

Covered Entity Details

Entity Name

Community Health Outreach Work to Prevent AIDS

Subdivision Name

Type

Ryan White Part B

340B ID

RWII968131

Entity Address

677 Ala Moana #226
Hawaii
Honolulu, HI 96813

Grant Number

X07HA00050

Participating Start Date

1/1/2018

Last Recertification Date

1/31/2024

Entity Termination Date

7/1/2024

Pharmacy Details

Pharmacy Name

5 MINUTE PHARMACY LTC LLC

Pharmacy Address

94-449 AKOKI ST STE 102
WAIPAHU, HI 96797-2732

Pharmacy Comments

Contract Details

Approval Date

1/10/2024

Contract Begin Date

4/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Heather Lusk, Executive Director
(808) 853-3292

Contract Pharmacy Representative

5 minute pharmacy
Derek Tengan, Owner
(808) 630-8388

Signed By Date

1/10/2024

340B Drug Pricing Program Database