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POLARIS PHARMACY SERVICES
STD967931 Department of Corrections and Rehabilitation, State of Hawaii
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Covered Entity Details
Entity Name
Department of Corrections and Rehabilitation, State of Hawaii
Subdivision Name
Maui Community Correctional Center
Type
Sexually Transmitted Diseases
340B ID
STD967931
Entity Address
600 Waiale Road
Wailuku, HI 96793
Grant Number
NU51PS005155-01-01
Participating Start Date
1/1/2024
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
POLARIS PHARMACY SERVICES
Pharmacy Address
125 TITUS AVE
WARRINGTON, PA 18976
Pharmacy Comments
Contract Details
Approval Date
4/15/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Romey J Glidewell, APRN, CHCA
(808) 587-1252
Contract Pharmacy Representative
Polaris Pharmacy Services
Jaime Lockett, Corrections Customer Care Manager
(267) 487-8900 Ext: 8904
Signed By Date
4/15/2025
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