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POLARIS PHARMACY SERVICES
STD967662 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
Kauai Community Correctional Center
Type
Sexually Transmitted Diseases
340B ID
STD967662
Entity Address
3-5351 Kuhio Highway
Lihue, HI 96766
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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