Durable Medical Equipment (Dme) Supplier License Application Instructions Page 2

DURABLE MEDICAL EQUIPMENT (DME) SUPPLIER LICENSE

APPLICATION INSTRUCTIONS

Page 2

Submission of Documents and Affidavit: The Hawaii business registration, Certificate of

Good Standing, and Hawaii General Excise Tax license may be obtained by registering

with the Hawaii Business Express, Department of Accounting and General Services at

https://hbe.ehawaii.gov. Submit the documents, read and agree to the conditions by

checking the check boxes, print your name, sign, and date.

Submit copies of all documents requested. Retain a copy of the application and

supporting documents for your own records. Submitted documents will not be returned.

Failure to submit all requested documents may result in processing delays and/or

the rejection of your application.

Submit applications to:

State of Hawaii, Department of Health

Office of Health Care Assurance

DME Licensing

601 Kamokila Boulevard, Room 337

Kapolei, Hawaii 96707

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