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WALGREEN OF HAWAII, LLC
CH093410 KOKUA KALIHI VALLEY COMPREHENSVIE FAMILY SERVICES
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Covered Entity Details
Entity Name
KOKUA KALIHI VALLEY COMPREHENSVIE FAMILY SERVICES
Subdivision Name
KOKUA KALIHI VALLEY MAIN CLINIC
Type
HRSA-Funded Health Center
340B ID
CH093410
Entity Address
2239 North School Street
HONOLULU, HI 96819
Grant Number
H80CS00776
Participating Start Date
7/1/1995
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
WALGREEN OF HAWAII, LLC
Pharmacy Address
DBA: WALGREENS #16100
1520 LILIHA ST STE 201
HONOLULU, HI 96817
Pharmacy Comments
Contract Details
Approval Date
4/3/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID DERAUF, Executive Director
(808) 791-9415
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/3/2018
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