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WALGREEN OF HAWAII LLC
DSH120005 HILO MEDICAL CENTER
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Covered Entity Details
Entity Name
HILO MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH120005
Entity Address
1190 WAIANUENUE AVENUE
HILO, HI 96720-2020
Medicare Provider Number
120005
Participating Start Date
4/1/2004
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
WALGREEN OF HAWAII LLC
Pharmacy Address
DBA: WALGREENS #16272 SPECIALTY PHARMACY
615 PIIKOI ST STE 105
HONOLULU, HI 96814
Pharmacy Comments
Contract Details
Approval Date
7/27/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dan Brinkman, CEO
(808) 932-3101
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/27/2017
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