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5 MINUTE PHARMACY KALIHI LLC
RWII968131 Community Health Outreach Work to Prevent AIDS
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Covered Entity Details
Entity Name
Community Health Outreach Work to Prevent AIDS
Subdivision Name
Type
Ryan White Part B
340B ID
RWII968131
Entity Address
677 Ala Moana #226
Hawaii
Honolulu, HI 96813
Grant Number
X07HA00050
Participating Start Date
1/1/2018
Last Recertification Date
1/31/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
5 MINUTE PHARMACY KALIHI LLC
Pharmacy Address
916 GULICK AVE
SUITE #A
HONOLULU, HI 96819
Pharmacy Comments
Contract Details
Approval Date
4/11/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Heather Lusk, Executive Director
(808) 853-3292
Contract Pharmacy Representative
5 minute pharmacy
Derek Tengan, Owner
(808) 630-8388
Signed By Date
4/11/2018
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