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5 MINUTE PHARMACY SPECIALTY, LLC
RWII96813 Life Foundation
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Covered Entity Details
Entity Name
Life Foundation
Subdivision Name
Type
Ryan White Part B
340B ID
RWII96813
Entity Address
677 Ala Moana Blvd, Ste 226
Honolulu, HI 96813
Grant Number
X07HA00050
Participating Start Date
10/1/2014
Last Recertification Date
1/26/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
5 MINUTE PHARMACY SPECIALTY, LLC
Pharmacy Address
94-216 FARRINGTON HWY. STE #B1-102C
WAIPAHU, HI 96797
Pharmacy Comments
Contract Details
Approval Date
10/16/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/7/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Groesbeck, Executive Director
(808) 853-3234
Contract Pharmacy Representative
5 minute pharmacy
Derek Tengan, Owner
(808) 630-8388
Signed By Date
10/16/2014
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