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MAUI PHARMACY SOLUTIONS LLC
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
MAUI PHARMACY SOLUTIONS LLC
Pharmacy Address
95 MAHALANI ST RM 28-5
WAILUKU, HI 96793
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Vaz, Chief Executive Officer
(808) 872-1052
Contract Pharmacy Representative
Mauliola Pharmacy
Cory Lehano, Pharmacist, Owner
(808) 446-3348
Signed By Date
4/12/2024
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