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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09099L WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED
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Covered Entity Details
Entity Name
WAIANAE DISTRICT COMPREHENSIVE HEALTH AND HOSPITAL BOARD, INCORPORATED
Subdivision Name
Waianae Intermediate School School-based Health Center
Type
HRSA-Funded Health Center
340B ID
CH09099L
Entity Address
85-626 FARRINGTON HWY
WAIANAE, HI 96792-2419
Grant Number
H80CS00807
Participating Start Date
7/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 09988
91 1401 FORT WEAVER RD
EWA BEACH, HI 96706
Pharmacy Comments
Contract Details
Approval Date
10/11/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RICHARD BETTINI, President & CEO
(808) 697-3300
Contract Pharmacy Representative
Waianae District Comprehensive Health & Hospital Board, Incorporated
Andrea Baltazar, 340B Program Specialist
(808) 697-3438
Signed By Date
10/11/2024
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