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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09099M 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
Ewa - West O`ahu Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH09099M
Entity Address
91-1841 Ft. Weaver Rd.
Ewa Beach, HI 96706
Grant Number
H80CS00807
Participating Start Date
10/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: LONGS DRUGS # 04728
1130 KUALA ST.
PEARL CITY, HI 96782
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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