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WALGREEN OF HAWAII, 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
WALGREEN OF HAWAII, LLC
Pharmacy Address
WALGREENS #15146
91-1081 KEAUNUI DRIVE
EWA BEACH, HI 96706
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
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