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MINA PHARMACY #11
CH093410 KOKUA KALIHI VALLEY COMPREHENSVIE FAMILY SERVICES
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Covered Entity Details
Entity Name
KOKUA KALIHI VALLEY COMPREHENSVIE FAMILY SERVICES
Subdivision Name
KOKUA KALIHI VALLEY MAIN CLINIC
Type
HRSA-Funded Health Center
340B ID
CH093410
Entity Address
2239 North School Street
HONOLULU, HI 96819
Grant Number
H80CS00776
Participating Start Date
7/1/1995
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
MINA PHARMACY #11
Pharmacy Address
1401 SOUTH BERETANIA STREET
SUITE 110
HONOLULU, HI 96814
Pharmacy Comments
Contract Details
Approval Date
10/12/2012
Contract Begin Date
10/12/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/22/2015
Ownership change
Contacts
Covered Entity Signing Official
DAVID DERAUF, Executive Director
(808) 791-9415
Contract Pharmacy Representative
Adel Etinas, President, CEO
(808) 738-4540
Signed By Date
9/24/2012
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