Contract Pharmacy Details

5 MINUTE PHARMACY LTC LLC
RWII96813 Life Foundation

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 LTC LLC

Pharmacy Address

94-449 AKOKI ST STE 102
WAIPAHU, HI 96797-2732

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

340B Drug Pricing Program Database