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WALGREEN OF MAUI, INC.
RWII96793 Maui A.I.D.S. Foundation
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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 MAUI, INC.
Pharmacy Address
DBA; WALGREENS #12786
10 E KAMEHAMEHA AVE
KAHULUI, HI 96732
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
2/8/2021
Business decision by covered entity and/or pharmacy
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
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