Contract Pharmacy Details

WALGREEN OF HAWAII, 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

WALGREEN OF HAWAII, LLC

Pharmacy Address

DBA: WALGREENS #13972
1121 S BERETANIA ST STE 1928
HONOLULU, HI 96814

Pharmacy Comments

Contract Details

Approval Date

10/14/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/26/2016
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Paul Groesbeck, Executive Director
(808) 853-3234

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/14/2015

340B Drug Pricing Program Database