Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09604F COMMUNITY CLINIC OF MAUI, INC.

Covered Entity Details

Entity Name

COMMUNITY CLINIC OF MAUI, INC.

Subdivision Name

Kahana Satellite

Type

HRSA-Funded Health Center

340B ID

CH09604F

Entity Address

10 Hoohui Rd, Ste 305
Lahaina, HI 96761-9259

Grant Number

H80CS00722

Participating Start Date

1/1/2025

Last Recertification Date

2/25/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: LONGS DRUGS # 09663
70 E KAAHUMANU AVE
KAHULUI, HI 96732

Pharmacy Comments

Contract Details

Approval Date

1/9/2025

Contract Begin Date

4/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John Vaz, Chief Executive Officer
(808) 872-1052

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/9/2025

340B Drug Pricing Program Database