Covered Entity Details

CH09288BN LIFELONG MEDICAL CARE (Approved) - information as of 5/15/2025 2:04:30 AM

Main Details

Name

LIFELONG MEDICAL CARE

Subdivision Name

LifeLong 433 Hegenberger

Type

HRSA-Funded Health Center

Site ID

BPS-H80-029723

340B ID

CH09288BN

Grant Number

H80CS00808

Additional Details

Current Program Status

Approved

Registration Date

4/4/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/6/2025

Last Recertification Date

Contacts

Authorizing Official

Lifelong Medical Care
Cecilia Aviles, Chief Executive Officer
(415) 812-1585

Primary Contact

Lifelong Medical Care
Ka Tung Hui, Pharmacy director
(510) 981-3248

Addresses

Street Address

433 Hegenberger Road STE 220
Oakland, CA 94621

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH092880	Active	BPS-H80-002401	Lifelong Medical Care	LIFELONG MEDICAL CARE	2344 6th St	Berkeley	CA
CH09288A	Active	BPS-H80-003021	Lifelong Medical Care	BERKELEY PRIMARY CARE	2001 DWIGHT WAY	BERKELEY	CA
CH09288AA	Active	BPS-H80-014319	LIFELONG MEDICAL CARE	Harrison Hotel - Supportive Housing Program	1415 HARRISON ST	OAKLAND	CA
CH09288AB	Terminated	BPS-H80-012497	LIFELONG MEDICAL CARE	LifeLong Berkeley City College	2050 Center St	Berkeley	CA
CH09288AC	Active	BPS-H80-012412	LIFELONG MEDICAL CARE	LifeLong New Highland/Rise Community School	8521 A St	Oakland	CA
CH09288AD	Terminated	BPS-H80-017334	LIFELONG MEDICAL CARE	LifeLong Medical Care-Pinole Health Center	1690 San Pablo Ave.	Pinole	CA
CH09288AE	Active	BPS-H80-015802	LIFELONG MEDICAL CARE	LifeLong TRUST Health Center	386 14th St	Oakland	CA
CH09288AF	Terminated	BPS-H80-014325	LIFELONG MEDICAL CARE	Bonita House HOST Program	1422 HARRISON ST	OAKLAND	CA
CH09288AG	Active	BPS-H80-014324	LIFELONG MEDICAL CARE	California Hotel - Supportive Housing Program	3501 SAN PABLO AVE	OAKLAND	CA
CH09288AH	Active	BPS-H80-014323	LIFELONG MEDICAL CARE	Dellums Apartment - Supportive Housing Program	644 14TH ST	OAKLAND	CA
CH09288AJ	Active	BPS-H80-014322	LIFELONG MEDICAL CARE	Martin Luthur King Homes - Supportive Housing Program	2942 MARTIN LUTHER KING JR WAY	BERKELEY	CA
CH09288AK	Terminated	BPS-H80-014339	LIFELONG MEDICAL CARE	Oaks Hotel - Supportive Housing Program	587 15TH ST	OAKLAND	CA
CH09288AL	Active	BPS-H80-014326	LIFELONG MEDICAL CARE	Erna P. Harris Court - Supportive Housing Program	1330 UNIVERSITY AVE	BERKELEY	CA
CH09288AM	Active	BPS-H80-014342	LIFELONG MEDICAL CARE	UA Homes - Supportive Housing Program	1040 UNIVERSITY AVE	BERKELEY	CA
CH09288AN	Active	BPS-H80-017715	LIFELONG MEDICAL CARE	LifeLong Rodeo Health Center	25 California St.	Rodeo	CA
CH09288AP	Terminated	BPS-H80-018854	LIFELONG MEDICAL CARE	Berkeley Food and Housing Project Women's Shelter- Supportive Housing Program	2140 DWIGHT WAY	BERKELEY	CA
CH09288AQ	Active	BPS-H80-018853	LIFELONG MEDICAL CARE	LifeLong Our Place - Supportive Housing Program	2577 San Pablo Ave	Oakland	CA
CH09288AR	Active	BPS-H80-018852	LIFELONG MEDICAL CARE	LifeLong The Savoy - Supportive Housing Program	1424 Jefferson Street	Oakland	CA
CH09288AS	Active	BPS-H80-018851	LIFELONG MEDICAL CARE	LifeLong Clinton Commons - Supportive Housing Program	720 E 11TH ST	OAKLAND	CA
CH09288AT	Active	BPS-H80-018850	LIFELONG MEDICAL CARE	LifeLong Berkeley Food and Housing, Russell Street Residence - Supportive Housing Program	1741 Russell Street	Berkeley	CA
CH09288AU	Active	BPS-H80-018849	LIFELONG MEDICAL CARE	LifeLong Project Pride - Supportive Housing Program	2545 San Pablo Ave.	Oakland	CA
CH09288AV	Active	BPS-H80-018208	LIFELONG MEDICAL CARE	Emeryville USD	4727 San Pablo Ave	Emeryville	CA
CH09288AW	Active	BPS-H80-015803	LIFELONG MEDICAL CARE	LifeLong William Jenkins Health Center	150 Harbour Way	RICHMOND	CA
CH09288AX	Active	BPS-H80-020794	Lifelong Medical Care	LifeLong West County Health Cetner - Pinole	806 San Pablo Ave	Pinole	CA
CH09288AY	Active	BPS-H80-022116	Lifelong Medical Care	LifeLong Lenoir Pediatric Health Center	2940 Summit Street	Oakland	CA
CH09288AZ	Active	BPS-H80-024388	Lifelong Medical Care	LifeLong East Bay Community Recovery Project West Oakland	2730 Adeline St	Oakland	CA
CH09288BA	Active	BPS-H80-032067	Lifelong Medical Care	LifeLong Eden Health Center	2045 Fairmont Drive	San Leandro	CA
CH09288BB	Active	BPS-H80-032387	Lifelong Medical Care	LifeLong Glenn Burke Wellness Center	3209 Lakeshore Ave	Oakland	CA
CH09288BC	Active	BPS-H80-032194	Lifelong Medical Care	LifeLong Street Medicine Van #1	2730 Adeline St	Oakland	CA
CH09288BD	Approved	BPS-H80-033097	LIFELONG MEDICAL CARE	LIfeLong Nova Apartments - Supportive Housing Program	445 30th St	Oakland	CA
CH09288BE	Approved	BPS-H80-032386	LIFELONG MEDICAL CARE	LifeLong Street Medicine Van #5	2730 Adeline St	Oakland	CA
CH09288BF	Approved	BPS-H80-033098	LIFELONG MEDICAL CARE	LifeLong Idaho Apartments - Supportive Housing Program	10203 San Pablo Ave	El Cerrito	CA
CH09288BG	Approved	BPS-H80-037532	LIFELONG MEDICAL CARE	LifeLong Brookside San Pablo Immediate/Urgent Care	2023 Vale Rd, Ste 103	San Pablo	CA
CH09288BH	Approved	BPS-H80-032388	LIFELONG MEDICAL CARE	LifeLong Street Medicine Van #4	2730 Adeline St	Oakland	CA
CH09288BJ	Approved	BPS-H80-032193	LIFELONG MEDICAL CARE	LifeLong Street Medicine Van #2	2730	Oakland	CA
CH09288BK	Approved	BPS-H80-039920	LIFELONG MEDICAL CARE	LifeLong Street Medicine Van #6	2730 Adeline St	Oakland	CA
CH09288BL	Approved	BPS-H80-032385	LIFELONG MEDICAL CARE	LifeLong Street Medicine Van #3	2730 Adeline St	Oakland	CA
CH09288BM	Approved	BPS-H80-033406	LIFELONG MEDICAL CARE	LifeLong 1701 MLK Housing - Supportive Housing Program	1701 Martin Luther King Jr Way	Oakland	CA
CH09288BN	Approved	BPS-H80-029723	LIFELONG MEDICAL CARE	LifeLong 433 Hegenberger	433 Hegenberger Road STE 220	Oakland	CA
CH09288BP	Approved	BPS-H80-033407	LIFELONG MEDICAL CARE	LIfeLong Empyrean Towers - Supportive Housing Program	344 13th St	Oakland	CA
CH09288BQ	Approved	BPS-H80-014693	LIFELONG MEDICAL CARE	Rosa Parks Collaborative	920 ALLSTON WAY	BERKELEY	CA
CH09288BR	Approved	BPS-H80-022137	LIFELONG MEDICAL CARE	LifeLong East Bay Community Recovery Project - Main Office	2579 San Pablo Ave	Oakland	CA
CH09288BS	Approved	BPS-H80-037531	LIFELONG MEDICAL CARE	LifeLong Brookside San Pablo Dental Care	2023 Vale Rd, Ste 114	San Pablo	CA
CH09288BT	Approved	BPS-H80-024623	LIFELONG MEDICAL CARE	LifeLong East Bay Community Recovery Project Hayward	22971 Sutro St	Hayward	CA
CH09288C	Active	BPS-H80-001114	Lifelong Medical Care	LMC - EAST OAKLAND CLINIC	10700 MACARTHUR BLVD	OAKLAND	CA
CH09288E	Active	BPS-H80-001325	Lifelong Medical Care	WEST BERKELEY FAMILY PRACTICE	837 Addison St	BERKELEY	CA
CH09288F	Active	BPS-H80-005648	Lifelong Medical Care	LIFELONG DENTAL CLINIC	1860 ALCATRAZ AVE	BERKELEY	CA
CH09288G	Active	BPS-H80-004692	Lifelong Medical Care	LifeLong Medical Care - Downtown Oakland Clinic	616 16th St	Oakland	CA
CH09288I	Active	BPS-H80-003722	Lifelong Medical Care	OVER 60 HEALTH CENTER - BERKELEY	3260 SACRAMENTO ST	BERKELEY	CA
CH09288J	Active	BPS-H80-006352	Lifelong Medical Care	LifeLong Medical Care - Howard J Daniel Clinic	9933 MacArthur Blvd	Oakland	CA
CH09288L	Active	BPS-H80-011966	Lifelong Medical Care	LifeLong Medical Care - Eastmont	7200 Bancroft Ave STE 125A	Oakland	CA
CH09288M	Terminated	BPS-H80-011487	Lifelong Medical Care	LifeLong Dr. William M. Jenkins, Jr. Pediatric Center	120 Broadway STE 4	Richmond	CA
CH09288N	Active	BPS-H80-011768	Lifelong Medical Care	LifeLong Medical Care--West Oakland	991 14th St	Oakland	CA
CH09288P	Active	BPS-H80-011769	Lifelong Medical Care	LifeLong Medical Care - Elmhurst	1800 98th Ave	Oakland	CA
CH09288Q	Active	BPS-H80-012256	Lifelong Medical Care	LifeLong Richmond	2600 MacDonald Ave. STE B	Richmond	CA
CH09288R	Active	BPS-H80-011232	Lifelong Medical Care	LifeLong Brookside Community Health Center San Pablo	2023 Vale Rd STE 107	San Pablo	CA
CH09288S	Terminated	BPS-H80-011233	LifeLong Medical Care	LifeLong Brookside Community Health Center Richmond	1030 Nevin Ave	Richmond	CA
CH09288T	Terminated	BPS-H80-007609	LIFELONG MEDICAL CARE	Marin County Adult Day Health Center	1905 Novato Blvd	Novato	CA
CH09288U	Terminated	BPS-H80-006862	LIFELONG MEDICAL CARE	SUPPORTIVE HOUSING PROGRAM	616 16th St	Oakland	CA
CH09288V	Active	BPS-H80-014428	LIFELONG MEDICAL CARE	Contra Costa County Dental Van	2023 VALE RD	SAN PABLO	CA
CH09288W	Active	BPS-H80-014568	LIFELONG MEDICAL CARE	LifeLong Dental Van	2344 6th St	Berkeley	CA
CH09288X	Terminated	BPS-H80-012977	LIFELONG MEDICAL CARE	LifeLong Ashby Health Center	3075 Adeline St. STE 280	Berkeley	CA
CH09288Y	Terminated	BPS-H80-014321	LIFELONG MEDICAL CARE	Bay Area Community Services(BACS) - Supportive Housing Program	2116 BROADWAY	OAKLAND	CA
CH09288Z	Terminated	BPS-H80-014320	LIFELONG MEDICAL CARE	Hamilton Apartments - Supportive Housing Program	510 21ST ST	OAKLAND	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH092880	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2024
CH092880	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2024
CH092880	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2024
CH092880	ACCREDO HEALTH GROUP INC	2410 WARDLOW RD	STE 101	CORONA	CA	92878	07/01/2024
CH092880	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2024
CH092880	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2024
CH092880	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2024
CH092880	AMAZON PHARMACY #001	4500 S PLEASANT VALLEY RD STE 201		AUSTIN	TX	78744-2911	04/01/2024
CH092880	AMAZON PHARMACY #006	3620 PLAINFIELD RD		INDIANAPOLIS	IN	46231-7003	04/01/2024
CH092880	AMAZON PHARMACY #008	408 TECHNOLOGY PARKWAY	BUILDING B, STE 101	COLLEGE STATION	TX	77845	04/01/2024
CH092880	AMAZON PHARMACY #009	7469 KINGSPOINTE PKWY STE 400		ORLANDO	FL	32819	07/01/2024
CH092880	AMAZON PHARMACY #010	1331 E 6TH ST		CORONA	CA	92879	07/01/2024
CH092880	AZ PHARMACY, LLC	DBA AMAZON PHARMACY #002	3809 E WATKINS ST	PHOENIX	AZ	85034	04/01/2024
CH092880	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2024
CH092880	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2024
CH092880	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2024
CH092880	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2024
CH092880	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2024
CH092880	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2024
CH092880	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2024
CH092880	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2024
CH092880	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2024
CH092880	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2024
CH092880	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2024
CH092880	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2024
CH092880	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2024
CH092880	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	07/01/2024
CH092880	DOLPHIN HEALTH PHARMACY	7400 MACARTHUR BLVD	SUITE A	OAKLAND	CA	94605	10/01/2016	01/06/2021
CH092880	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2024
CH092880	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2024
CH092880	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2024
CH092880	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16118	4301 CENTURY BLVD	PITTSBURG	CA	94565	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16764	15555 E 14TH ST STE 400	SAN LEANDRO	CA	94578	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #17781	2650 BROADWAY	OAKLAND	CA	94612	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16222	1400 FITZGERALD DR	PINOLE	CA	94564	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY # 8431	7200 BANCROFT AVE.	OAKLAND	CA	94605	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16837	4500 MACDONALD AVE	RICHMOND	CA	94805	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS/PHARMACY # 17712	1414 UNIVERSITY AVE	BERKELEY	CA	94702	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS/PHARMACY # 11339	777 S. HARBOR BLVD., SUITE E-164	LA HABRA	CA	90631	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17044	1057 EASTSHORE HWY	ALBANY	CA	94710	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY # 10121	2655 TELEGRAPH AVE.	BERKELEY	CA	94704	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10199	26059 MISSION BLVD	HAYWARD	CA	94544	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17624	1555 40TH STREET	EMERYVILLE	CA	94608	01/01/2024
CH092880	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17673	2187 SHATTUCK AVE	BERKELEY	CA	94704	01/01/2024
CH092880	GENOA HEALTHCARE LLC	245 11TH ST STE P1		SAN FRANCISCO	CA	94103	07/01/2024
CH092880	IC PHARMACY LLC	AMAZON PHARMACY #004	34 35TH STREET STE 4BSW, UNIT 28	BROOKLYN	NY	11232	04/01/2024
CH09288E	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03026	2300 SHATTUCK AVE	BERKELEY	CA	94704	03/15/2007	11/19/2015
CH09288C	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09942	1401 WASHINGTON AVE	SAN LEANDRO	CA	94577	04/15/2008	11/19/2015
CH09288A	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03026	2300 SHATTUCK AVE	BERKELEY	CA	94704	10/29/2007	11/19/2015
CH09288I	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09553	4349 SAN PABLO AVE	EMERYVILLE	CA	94608	10/29/2007	11/19/2015
CH09288G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09957	344 THOMAS L. BERKLEY WAY	OAKLAND	CA	94612	07/06/2006	11/19/2015
CH09288F	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03026	2300 SHATTUCK AVE	BERKELEY	CA	94704	04/15/2008	03/29/2019
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09509	4424 TREAT BLVD	CONCORD	CA	94521	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09938	3625 MT DIABLO BLVD	LAFAYETTE	CA	94549	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09904	3667 CASTRO VALLEY BLVD	CASTRO VALLEY	CA	94546	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA CVS/PHARMACY # 4326	4028 LONE TREE WAY	ANTIOCH	CA	94531	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03078	2151 MEEKER AVE	RICHMOND	CA	94804	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09832	3678 SONOMA BLVD	VALLEJO	CA	94590	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09595	1382 SOLANO AVE	ALBANY	CA	94706	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09299	1617 CANYON DR	PINOLE	CA	94564	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09378	4100 REDWOOD RD	OAKLAND	CA	94619	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09130	175 41ST ST	OAKLAND	CA	94611	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09226	3320 FRUITVALE AVE	OAKLAND	CA	94602	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 04151	2050 CLUB CENTER DR	SACRAMENTO	CA	95835	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09635	1550 EAST 14TH STREET	SAN LEANDRO	CA	94577	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09128	2314 SANTA CLARA AVE	ALAMEDA	CA	94501	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09876	699 LEWELLING BLVD	SAN LEANDRO	CA	94579	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09600	35720 FREMONT BLVD	FREMONT	CA	94536	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09939	50 MORAGA WAY	ORINDA	CA	94563	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09086	670 EL CERRITO PLZ	EL CERRITO	CA	94530	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09941	1451 SHATTUCK AVE	BERKELEY	CA	94709	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09929	2000 MOUNTAIN BLVD	OAKLAND	CA	94611	01/01/2024
CH092880	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09942	1401 WASHINGTON AVE	SAN LEANDRO	CA	94577	01/01/2024
CH092880	M.N. PHARMACY LLC	DBA AMAZON PHARMACY #003	6701 NW 7TH ST., STE. #199	MIAMI	FL	33126	04/01/2024
CH092880	MIDTOWN PHARMACY PROFESSIONAL CORPORATIO	2173 HARBOR BAY PARKWAY		ALAMEDA	CA	94502-3019	01/01/2022
CH092880	OPTUM PHARMACY 701, LLC	8131 W BOSTIAN RD STE A350		WOODINVILLE	WA	98072-5029	07/01/2024
CH092880	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	07/01/2024
CH092880	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	07/01/2024
CH092880	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2024
CH092880	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/01/2024
CH092880	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	07/01/2024
CH092880	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	07/01/2024
CH092880	PILLPACK LLC	DBA PILLPACK BY AMAZON PHARMACY	250 COMMERCIAL ST STE 2012	MANCHESTER	NH	03101	04/01/2024
CH092880	PILLPACK LLC	AMAZON PHARMACY #005	20416 72ND AVE S	KENT	WA	98032-2319	04/01/2024
CH092880	PILLPACK LLC	AMAZON PHARMACY #007	1820 S SILVERSTONE WAY STES 200 & 300	MERIDIAN	ID	83642	04/01/2024
CH092880	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2024
CH09288C	PROCARE PHARMACY, L.L.C.	DBA: CAREPLUS CVS/PHARMACY # 02822	3031 TELEGRAPH AVENUE SUITE 115	BERKELEY	CA	94705	04/01/2013	11/19/2015
CH09288A	PROCARE PHARMACY, L.L.C.	DBA: CAREPLUS CVS/PHARMACY # 02822	3031 TELEGRAPH AVENUE SUITE 115	BERKELEY	CA	94705	11/26/2012	11/19/2015
CH092880	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2024
CH092880	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2024
CH092880	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY	445 CASTRO STREET	SAN FRANCISCO	CA	94114	01/01/2024
CH092880	SAFEWAY INC	SAFEWAY PHARMACY #3132	5100 BROADWAY	OAKLAND	CA	94611	01/01/2024
CH092880	SAFEWAY INC	SAFEWAY PHARMACY #0691	1444 SHATTUCK PLACE	BERKELEY	CA	94709	01/01/2024
CH092880	VALE ROAD PHARMACY	2023 VALE RD STE 101		SAN PABLO	CA	94806-3891	10/01/2016
CH092880	WAL-MART PHARMACY #5434	15555 HESPERIAN BLVD.		SAN LEANDRO	CA	94579	07/01/2018	10/10/2019
CH092880	WAL-MART PHARMACY 10-2648	1919 DAVIS STREET		SAN LEANDRO	CA	94577	07/01/2018	10/10/2019
CH092880	WAL-MART PHARMACY 10-3455	1400 HILLTOP MALL RD		RICHMOND	CA	94806	07/01/2018	10/10/2019
CH092880	WALGREEN CO	DBA: WALGREENS #11614	2750 PINOLE VALLEY RD	PINOLE	CA	94564	10/19/2012
CH092880	WALGREEN CO	DBA: WALGREENS #10526	3250 LAKESHORE AVE STE B	OAKLAND	CA	94610-2720	10/19/2012
CH092880	WALGREEN CO	DBA: WALGREENS #10045	2310 TELEGRAPH AVE	BERKELEY	CA	94704	10/19/2012
CH092880	WALGREEN CO	DBA: WALGREENS	2370 E MAIN STREET	WOODLAND	CA	95776	10/19/2012	11/06/2015
CH092880	WALGREEN CO.	DBA: WALGREENS # 00063	900 RALSTON AVENUE	BELMONT	CA	94002	10/19/2012	11/16/2021
CH092880	WALGREEN CO.	DBA: WALGREENS # 00324	216 WESTLAKE CENTER	DALY CITY	CA	94015	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 01126	1979 MISSION STREET	SAN FRANCISCO	CA	94103	10/19/2012	12/26/2019
CH092880	WALGREEN CO.	DBA: WALGREENS # 02521	300 MONTGOMERY ST STE 150	SAN FRANCISCO	CA	94104	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 05618	100 SANSOME ST	SAN FRANCISCO	CA	94104	10/19/2012	11/07/2019
CH092880	WALGREEN CO.	DBA: WALGREENS # 04275	456 MISSION STREET	SAN FRANCISCO	CA	94105	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 06291	116 NEW MONTGOMERY ST	SAN FRANCISCO	CA	94105	10/19/2012	11/13/2019
CH092880	WALGREEN CO.	DBA: WALGREENS # 07044	88 SPEAR STREET	SAN FRANCISCO	CA	94105	10/19/2012	02/23/2022
CH092880	WALGREEN CO.	DBA: WALGREENS # 05599	2120 POLK STREET	SAN FRANCISCO	CA	94109	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 03711	1189 POTRERO AVE	SAN FRANCISCO	CA	94110	10/19/2012	02/26/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 01393	1630 OCEAN AVE	SAN FRANCISCO	CA	94112	10/19/2012	02/27/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 01327	498 CASTRO ST	SAN FRANCISCO	CA	94114	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 03475	25 POINT LOBOS AVE	SAN FRANCISCO	CA	94121	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 04180	685 PORTOLA DRIVE	SAN FRANCISCO	CA	94127	10/19/2012	10/09/2015
CH092880	WALGREEN CO.	DBA: WALGREENS # 01109	5260 DIAMOND HEIGHTS BLVD	SAN FRANCISCO	CA	94131	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 04050	1916 WEBSTER ST.	ALAMEDA	CA	94501	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 09248	2300 OTIS DRIVE	ALAMEDA	CA	94501	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 03164	1800 CONCORD AVE	CONCORD	CA	94520	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 05864	721 GREGORY LANE	PLEASANT HILL	CA	94523-2763	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 03770	11565 SAN PABLO AVE	EL CERRITO	CA	94530	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 04724	3416 DEER VALLEY RD.	ANTIOCH	CA	94531-6650	10/19/2012	11/07/2024
CH092880	WALGREEN CO.	DBA: WALGREENS # 01940	1955 W TEXAS STREET	FAIRFIELD	CA	94533	10/19/2012	02/28/2022
CH092880	WALGREEN CO.	DBA: WALGREENS # 02660	41400 BLACOW RD	FREMONT	CA	94538	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 04517	2600 MOWRY AVE	FREMONT	CA	94538	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 02401	21463 FOOTHILL BLVD.	HAYWARD	CA	94541	10/19/2012	04/15/2024
CH092880	WALGREEN CO.	DBA: WALGREENS # 06502	23958 HESPERIAN BLVD	HAYWARD	CA	94541-7241	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 02306	1138 W TENNYSON RD	HAYWARD	CA	94544	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 04659	164 W. JACKSON ST.	HAYWARD	CA	94544	10/19/2012	05/19/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 00101	3382 CASTRO VALLEY BLVD	CASTRO VALLEY	CA	94546	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 07376	2901 RAILROAD AVE	PITTSBURG	CA	94565-5224	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS #13026	2700 WILLOW PASS RD	BAY POINT	CA	94565	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 03032	15850 E 14TH STREET	SAN LEANDRO	CA	94578	10/19/2012	02/21/2017
CH092880	WALGREEN CO.	DBA: WALGREENS # 07274	1456 136TH AVE	SAN LEANDRO	CA	94578-2552	10/19/2012	03/27/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 02426	15500 WASHINGTON AVE	SAN LEANDRO	CA	94579	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 03171	1050 REDWOOD STREET	VALLEJO	CA	94590	10/19/2012	02/25/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 02575	2647 SPRINGS ROAD	VALLEJO	CA	94591	10/19/2012	02/27/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 04026	2900 N MAIN ST	WALNUT CREEK	CA	94597	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 01537	3232 FOOTHILL BLVD	OAKLAND	CA	94601	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS #11706	301 E. 18TH STREET	OAKLAND	CA	94606-1813	10/19/2012	02/24/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 01625	5055 TELEGRAPH AVE	OAKLAND	CA	94609	10/19/2012	02/27/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 03170	3400 TELEGRAPH AVENUE	OAKLAND	CA	94609	10/19/2012	11/08/2022
CH092880	WALGREEN CO.	DBA: WALGREENS # 13595	1333 BROADWAY STE 145	OAKLAND	CA	94612	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 01536	3434 HIGH STREET	OAKLAND	CA	94619	10/19/2012	01/22/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 03295	8102 INTERNATIONAL BLVD	OAKLAND	CA	94621	10/19/2012	07/29/2021
CH092880	WALGREEN CO.	DBA: WALGREENS # 02609	2995 SAN PABLO AVE.	BERKELEY	CA	94702	10/19/2012	11/17/2021
CH092880	WALGREEN CO.	DBA: WALGREENS # 04614	2801 ADELINE ST	BERKELEY	CA	94703	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS #13858	1607 SHATTUCK AVE.	BERKLEY	CA	94709	10/19/2012	11/10/2020
CH092880	WALGREEN CO.	DBA: WALGREENS # 02314	1050 GILMAN ST	BERKELEY	CA	94710	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 02506	1150 MACDONALD AVE	RICHMOND	CA	94801	10/19/2012	01/30/2025
CH092880	WALGREEN CO.	DBA: WALGREENS # 04049	3630 SAN PABLO DAM RD	EL SOBRANTE	CA	94803	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 15947	13691 SAN PABLO AVE	SAN PABLO	CA	94806	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 04491	15650 SAN PABLO AVE.	SAN PABLO	CA	94806	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS #13796	14280 SAN PABLO AVE	SAN PABLO	CA	94806	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 04625	830 3RD STREET	SAN RAFAEL	CA	94901	10/19/2012
CH092880	WALGREEN CO.	DBA: WALGREENS # 15025	2190 SHATTUCK AVENUE	BERKELEY	CA	94704-1307	04/01/2013	08/23/2023
CH092880	WALGREEN CO.	DBA: WALGREENS # 03707	2100 WEBSTER STREET SUITE 105	SAN FRANCISCO	CA	94115	01/01/2016
CH092880	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #16477	3009 BROADWAY	OAKLAND	CA	94611	04/01/2017
CH092880	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15296	2262 MARKET ST	SAN FRANCISCO	CA	94114	07/01/2017
CH092880	WALGREEN CO.	WALGREENS #15330	5809 FOOTHILL BLVD	OAKLAND	CA	94605	07/01/2019	01/30/2025
CH092880	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21193	1757 W SAN CARLOS ST	SAN JOSE	CA	95128	07/01/2024
CH092880	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013
CH092880	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	11/06/2015
CH092880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	07/01/2024
CH092880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/01/2024
CH092880	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Aviles, Cecilia Chief Executive Officer Lifelong Medical Care 4158121585	5/6/2025 2:12 PM
Details	340B ID	Update	New Registration		CH09288BN	5/6/2025 2:12 PM
Dates	Participating Approval Date	Update	New Registration		5/6/2025 2:12:57 PM	5/6/2025 2:12 PM
Details	State	Update	New Registration	Pending	Approved	5/6/2025 2:12 PM
Dates	Signed By Date	Update	New Registration		4/8/2025 10:32:03 PM	5/6/2025 2:12 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/6/2025 2:12 PM
Addresses	Main Address	Insert	New Registration		433 Hegenberger Road STE 220 Oakland, CA 94621	4/4/2025 8:25 PM
Contacts	Primary Contact	Insert	New Registration		Hui, Ka Tung Pharmacy director Lifelong Medical Care 5109813248	4/4/2025 8:25 PM
Contacts	Authorizing Official	Insert	New Registration		Aviles, Cecilia Chief Executive Officer Lifelong Medical Care 4158121585	4/4/2025 8:25 PM
Details	Assistance Received From Date	Insert	New Registration			4/4/2025 8:25 PM
Details	Assistance Received To Date	Insert	New Registration			4/4/2025 8:25 PM
Details	Last Recertification Date	Insert	New Registration			4/4/2025 8:25 PM
Details	Grant Number	Insert	New Registration		H80CS00808	4/4/2025 8:25 PM
Details	340B ID	Insert	New Registration			4/4/2025 8:25 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/4/2025 8:25 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/4/2025 8:25 PM
Details	Medicare Provider Number	Insert	New Registration			4/4/2025 8:25 PM
Details	Entity Name	Insert	New Registration		LIFELONG MEDICAL CARE	4/4/2025 8:25 PM
Details	NOFO Number	Insert	New Registration			4/4/2025 8:25 PM
Details	Program Code	Insert	New Registration		CH	4/4/2025 8:25 PM
Details	Entity Subname	Insert	New Registration		LifeLong 433 Hegenberger	4/4/2025 8:25 PM
Dates	Participating Approval Date	Insert	New Registration			4/4/2025 8:25 PM
Details	State	Insert	New Registration		Pending	4/4/2025 8:25 PM
Dates	Registration Date	Insert	New Registration		4/4/2025 8:25:51 PM	4/4/2025 8:25 PM
Dates	Signed By Date	Insert	New Registration			4/4/2025 8:25 PM
Dates	Start Date	Insert	New Registration			4/4/2025 8:25 PM
Terminations	Termination Comments	Insert	New Registration			4/4/2025 8:25 PM
Terminations	Termination Date	Insert	New Registration			4/4/2025 8:25 PM
Terminations	Termination Effective Date	Insert	New Registration			4/4/2025 8:25 PM
Terminations	Termination Reason	Insert	New Registration			4/4/2025 8:25 PM

340B Drug Pricing Program Database