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5 MINUTE PHARMACY KALIHI LLC
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
5 MINUTE PHARMACY KALIHI LLC
Pharmacy Address
916 GULICK AVE
SUITE #A
HONOLULU, HI 96819
Pharmacy Comments
Contract Details
Approval Date
4/23/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/24/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
DAVID DERAUF, Executive Director
(808) 791-9415
Contract Pharmacy Representative
5 minute pharmacy
Derek Tengan, Owner
(808) 630-8388
Signed By Date
4/23/2015
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