Contract Pharmacy Details

WALGREEN OF HAWAII, LLC.
RWII96793 Maui A.I.D.S. Foundation

Covered Entity Details

Entity Name

Maui A.I.D.S. Foundation

Subdivision Name

Type

Ryan White Part B

340B ID

RWII96793

Entity Address

1935 Main St.
Suite 101
Wailuku, HI 96793-1784

Grant Number

X07HA00050

Participating Start Date

10/1/2016

Last Recertification Date

2/23/2023

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

WALGREEN OF HAWAII, LLC.

Pharmacy Address

DBA: WALGREENS #12764
99 SOUTH MARKET STREET, SUITE 201
WAILUKU, HI 96793

Pharmacy Comments

Contract Details

Approval Date

10/17/2016

Contract Begin Date

1/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/24/2018
Pharmacy closed

Contacts

Covered Entity Signing Official

Steven F. HIre, Board President
(808) 242-4900 Ext: 5342

Contract Pharmacy Representative

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

Signed By Date

10/17/2016

340B Drug Pricing Program Database