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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH092537A Ko'olauloa Health Center
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Covered Entity Details
Entity Name
Ko'olauloa Health Center
Subdivision Name
Hau'ula Clinic
Type
HRSA-Funded Health Center
340B ID
CH092537A
Entity Address
54-316 Kamehameha Hwy Suite 6 & 7
Hauula, HI 96717
Grant Number
H80CS06641
Participating Start Date
4/1/2011
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 03070
66-197 KAMEHAMEHA HWY., #1
HALEIWA, HI 96712
Pharmacy Comments
Contract Details
Approval Date
7/2/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
TERRENCE ARATANI, CHIEF EXECUTIVE OFFICER
(808) 792-3840
Contract Pharmacy Representative
Ko'olauloa Health Center
Allen John Bagalso, Director of Pharmacy
(808) 293-9514
Signed By Date
7/2/2024
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