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QUEEN'S POB III PHARMACY
DSH120001 THE QUEEN'S MEDICAL CENTER
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Covered Entity Details
Entity Name
THE QUEEN'S MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH120001
Entity Address
1301 PUNCHBOWL STREET
HONOLULU, HI 96813-2499
Medicare Provider Number
120001
Participating Start Date
7/1/2002
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
QUEEN'S POB III PHARMACY
Pharmacy Address
550 S BERETANIA ST STE 102
HONOLULU, HI 96813
Pharmacy Comments
Contract Details
Approval Date
8/8/2011
Contract Begin Date
8/8/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/28/2011
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