Covered Entity Details

CH091963N LIVINGSTON COMMUNITY HEALTH (Approved) - information as of 5/30/2025 8:18:33 PM

Main Details

Name

LIVINGSTON COMMUNITY HEALTH

Subdivision Name

Modesto Health Center - Florida Ave

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039813

340B ID

CH091963N

Grant Number

H80CS02588

Additional Details

Current Program Status

Approved

Registration Date

4/8/2025

Participating Start Date

7/1/2025

Participating Approval Date

5/6/2025

Last Recertification Date

Contacts

Authorizing Official

Livingston Community Health
Leslie Abasta-Cummings, Chief Executive Officer
(209) 850-3545

Primary Contact

Livingston Community Health
Erin Pilot, Chief Financial Officer
(209) 850-3500 Ext: 1362

Addresses

Street Address

1444 Florida Ave, Suite 202
Modesto, CA 95350-4400

Billing Address

Livingston Community Health
600 B Street, Bldg A
Livingston, CA 95334

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?
Yes

State	Medicaid Number	NPI Number
CA		1427110329

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
CH0919630	Terminated	BPS-H80-003882	LIVINGSTON COMMUNITY HEALTH	LIVINGSTON HEALTH CENTER	1140 MAIN STREET	LIVINGSTON	CA
CH091963A	Active	BPS-H80-012658	LIVINGSTON COMMUNITY HEALTH	Hilmar Health Center	7970 Lander Ave STE A/B	Hilmar	CA
CH091963B	Active	BPS-H80-016845	LIVINGSTON COMMUNITY HEALTH	Bentley Health Center	12633 BENTLEY ST	WATERFORD	CA
CH091963C	Active	BPS-H80-016843	LIVINGSTON COMMUNITY HEALTH	Bentley Health Center	12619 BENTLEY ST	WATERFORD	CA
CH091963D	Active	BPS-H80-018443	LIVINGSTON COMMUNITY HEALTH	Wolves Wellness Center	1617 Main St. RM 200 & 201	Livingston	CA
CH091963E	Terminated	BPS-H80-018376	LIVINGSTON COMMUNITY HEALTH	Las Palmas	1010 W. Las Palmas Avenue, Suite E	Patterson	CA
CH091963F	Active	BPS-H80-019273	LIVINGSTON COMMUNITY HEALTH	Delhi Health Center	16233 W King Street	Delhi	CA
CH091963G	Active	BPS-H80-024902	LIVINGSTON COMMUNITY HEALTH	Livingston Community Health Campus, B Street, Buildings A, B, C	600 B Street BLDG A, B, C	Livingston	CA
CH091963H	Active	BPS-H80-038382	LIVINGSTON COMMUNITY HEALTH	Turlock Health Center	2141 Colorado Ave	Turlock	CA
CH091963J	Active	BPS-H80-030330	LIVINGSTON COMMUNITY HEALTH	Hughson Health Center	2412 3rd St Ste B	Hughson	CA
CH091963K	Active	BPS-H80-035552	LIVINGSTON COMMUNITY HEALTH	Modesto Health Center	2116 E. Orangeburg Avenue	Modesto	CA
CH091963L	Active	BPS-H80-037411	LIVINGSTON COMMUNITY HEALTH	MUHSD East Campus Health Center	125 E 18th St	Merced	CA
CH091963M	ToBeTerminated	BPS-H80-039164	LIVINGSTON COMMUNITY HEALTH	Modesto Health Center - Florida Ave	1444 Florida Ave	Modesto	CA
CH091963N	Approved	BPS-H80-039813	LIVINGSTON COMMUNITY HEALTH	Modesto Health Center - Florida Ave	1444 Florida Ave, Suite 202	Modesto	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH091963G	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/01/2024
CH091963G	ACCREDO HEALTH GROUP INC	2410 WARDLOW RD	STE 101	CORONA	CA	92878	07/01/2024
CH091963G	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/01/2024
CH091963G	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/01/2024
CH091963G	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/01/2024
CH091963G	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	07/01/2024
CH091963G	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/01/2024
CH091963G	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/01/2025
CH091963G	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2025
CH091963G	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2025
CH091963G	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2025
CH091963G	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2025
CH091963G	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2025
CH091963G	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2025
CH091963G	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2025
CH091963G	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2025
CH091963G	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2025
CH091963G	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/01/2025
CH091963G	CARRANZA PHARMACY HUGHSON	2431 3RD ST	SUITE A	HUGHSON	CA	95326	04/01/2024
CH091963G	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/01/2022
CH091963G	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/01/2022
CH091963G	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/01/2025
CH091963G	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/01/2024
CH091963G	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/01/2024
CH091963G	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	07/01/2024
CH091963G	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/01/2024
CH091963G	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/01/2024
CH0919630	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10360	474 WINTON PKWY	LIVINGSTON	CA	95334	01/01/2017	04/01/2021
CH0919630	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03117	1651 BELLEVUE RD	ATWATER	CA	95301	01/01/2019	04/01/2021
CH0919630	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17449	1000 COMMERCE AVE	ATWATER	CA	95301	01/01/2019	04/01/2021
CH091963G	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 16647	3000 COUNTRYSIDE DR	TURLOCK	CA	95380	04/23/2021
CH091963G	GARFIELD BEACH CVS, L.L.C.	CVS PHARMACY # 17449	1000 COMMERCE AVE	ATWATER	CA	95301	04/23/2021
CH091963G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 02994	3100 GEER RD.	TURLOCK	CA	95382	04/23/2021	04/23/2021
CH091963G	GARFIELD BEACH CVS, L.L.C.	DBA CVS/PHARMACY #10360	474 WINTON PKWY	LIVINGSTON	CA	95334	04/23/2021
CH091963G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 03117	1651 BELLEVUE RD	ATWATER	CA	95301	04/23/2021
CH091963G	GARFIELD BEACH CVS, L.L.C.	DBA: CVS/PHARMACY # 02994	3100 GEER RD.	TURLOCK	CA	95382	04/01/2025
CH091963G	GENOA HEALTHCARE LLC	2550 WEST CLINTON AVE STE 123		FRESNO	CA	93705	01/01/2025
CH091963G	GILL PHARMACY WATERFORD	GILL PHARMACY INC	12648 BENTLEY ST	WATERFORD	CA	95386	04/01/2024
CH0919630	GKN RX INC	1471 B ST STE R		LIVINGSTON	CA	95334-1426	07/01/2017	04/16/2019
CH091963G	LCH PHARMACY	600 B ST BLDG B ROOM 100		LIVINGSTON	CA	95334	04/23/2021	04/23/2021
CH0919630	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09919	1621 LANDER AVE	TURLOCK	CA	95380	01/01/2017	04/01/2021
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09919	1621 LANDER AVE	TURLOCK	CA	95380	04/23/2021
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09248	1700 MCHENRY AVE.	MODESTO	CA	95350	07/01/2022
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09884	2601 OAKDALE RD STE E	MODESTO	CA	95355	07/01/2022
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09874	2075 E HATCH ROAD	MODESTO	CA	95351	07/01/2022
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09171	2900 STANDIFORD AVE	MODESTO	CA	95350	07/01/2022
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03079	2224 PATTERSON RD	RIVERBANK	CA	95367	07/01/2022
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 03944	1520 E F ST	OAKDALE	CA	95361	07/01/2022
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 07206	1970 YOSEMITE PARKWAY	MERCED	CA	95341	07/01/2022
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09308	901 N CARPENTER RD STE 30	MODESTO	CA	95351	07/01/2022
CH091963G	LONGS DRUG STORES CALIFORNIA, L.L.C.	DBA: CVS/PHARMACY # 09623	649 W. OLIVE AVENUE	MERCED	CA	95348	07/01/2022
CH091963G	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	01/01/2025
CH091963G	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	01/01/2025
CH091963G	OPTUM PHARMACY 707, INC	4900 RIVERGRADE RD STE E110		IRWINDALE	CA	91706-1401	01/01/2025
CH091963G	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2025
CH091963G	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/01/2025
CH091963G	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2025
CH0919630	ROL'S DELHI DRUG STORE		9724 STEPHENS STREET	DELHI	CA	95315	02/10/2006	07/20/2016
CH091963G	TARGET STORES A DIV. OF TARGET CORP.	ATTN PHARMACY	TARGET STORE T-2386 1000 COMMERCE AVE	ATWATER	CA	95301	04/23/2021	04/23/2021
CH091963G	TARGET STORES A DIV.OF TARGET CORP.	TARGET STORE T-1304	ATTN: PHARMACY 3000 COUNTRYSIDE DRIVE	TURLOCK	CA	95380	04/23/2021	04/23/2021
CH0919630	THRIFTY PAYLESS, INC.	RITE AID #6379	500 MAIN STREET	LIVINGSTON	CA	95334	01/01/2017	04/01/2021
CH091963G	THRIFTY PAYLESS, INC.	RITE AID #6379	500 MAIN STREET	LIVINGSTON	CA	95334	04/23/2021
CH091963G	THRIFTY PAYLESS, INC.	RITE AID #6019	653 N GOLDEN STATE BLVD	TURLOCK	CA	95380-3952	04/23/2021	04/23/2021
CH091963G	THRIFTY PAYLESS, INC.	RITE AID #6001	571 BELLEVUE ROAD	ATWATER	CA	95301	04/23/2021	04/23/2021
CH091963G	THRIFTY PAYLESS, INC.	RITE AID #6512	1000 W MONTE VISTA AVENUE	TURLOCK	CA	95382	04/23/2021	04/23/2021
CH091963G	THRIFTY PAYLESS, INC.	RITE AID #6019	653 N GOLDEN STATE BLVD	TURLOCK	CA	95380-3952	04/01/2025
CH091963G	THRIFTY PAYLESS, INC.	RITE AID #6512	1000 W MONTE VISTA AVENUE	TURLOCK	CA	95382	04/01/2025
CH0919630	WAL-MART PHARMACY 10-1963	2111 FULKERTH RD		TURLOCK	CA	95380	01/01/2017	04/01/2021
CH091963G	WAL-MART PHARMACY 10-1963	2111 FULKERTH RD		TURLOCK	CA	95380	04/23/2021
CH0919630	WAL-MART PHARMACY 10-3047	2480 GEER RD		TURLOCK	CA	95380	01/01/2017	04/01/2021
CH091963G	WAL-MART PHARMACY 10-3047	2480 GEER RD		TURLOCK	CA	95380	04/23/2021
CH0919630	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	01/01/2017	04/01/2021
CH091963G	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	04/23/2021
CH0919630	WAL-MART PHARMACY 10-5394	770 WEST EL MONTE WAY		DINUBA	CA	93618	01/01/2017	01/24/2017
CH0919630	WAL-MART PHARMACY 10-5843	1030 SPERRY AVE		PATTERSON	CA	95363	04/01/2018	04/01/2021
CH091963G	WAL-MART PHARMACY 10-5843	1030 SPERRY AVE		PATTERSON	CA	95363	04/23/2021
CH0919630	WAL-MART PHARMACY 10-5890	800 COMMERCE AVE.		ATWATER	CA	95301	01/01/2017	04/01/2021
CH091963G	WAL-MART PHARMACY 10-5890	800 COMMERCE AVE.		ATWATER	CA	95301	04/23/2021
CH0919630	WALGREEN CO.	DBA: WALGREENS # 03030	1591 GEER ROAD	TURLOCK	CA	95380	10/01/2014	04/01/2021
CH0919630	WALGREEN CO.	DBA: WALGREENS # 06718	2730 SHAFFER ROAD	ATWATER	CA	95301	10/01/2014	04/01/2021
CH0919630	WALGREEN CO.	DBA: WALGREENS #15986	8298 LANDER AVE	HILMAR	CA	95324	10/01/2014	04/01/2021
CH0919630	WALGREEN CO.	DBA: WALGREENS # 03330	1640 R STREET	MERCED	CA	95340	04/01/2018	04/01/2021
CH0919630	WALGREEN CO.	DBA: WALGREENS #09955	995 SPERRY AVE	PATTERSON	CA	95363	04/01/2018	04/01/2021
CH091963G	WALGREEN CO.	DBA: WALGREENS #09955	995 SPERRY AVE	PATTERSON	CA	95363	04/23/2021
CH091963G	WALGREEN CO.	DBA: WALGREENS # 06718	2730 SHAFFER ROAD	ATWATER	CA	95301	04/23/2021
CH091963G	WALGREEN CO.	DBA: WALGREENS # 03330	1640 R STREET	MERCED	CA	95340	04/23/2021
CH091963G	WALGREEN CO.	DBA: WALGREENS #15986	8298 LANDER AVE	HILMAR	CA	95324	04/23/2021
CH091963G	WALGREEN CO.	DBA: WALGREENS # 03030	1591 GEER ROAD	TURLOCK	CA	95380	07/01/2021
CH091963G	WALGREEN CO.	DBA: WALGREENS # 02902	2101 E HATCH RD	MODESTO	CA	95351	04/01/2022
CH0919630	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	10/01/2014	07/09/2015
CH0919630	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	10/01/2014	07/09/2015
CH091963G	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/01/2024
CH091963G	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/01/2024
CH091963G	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/01/2024
CH091963G	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	10/01/2023
CH0919630	WELLPARTNER, INC	20800 SW 115TH AVE	SUITE 100	TUALATIN	OR	97062	01/01/2017	02/05/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Abasta-Cummings, Leslie Chief Executive Officer Livingston Community Health 2098503545	5/6/2025 2:09 PM
Details	340B ID	Update	New Registration		CH091963N	5/6/2025 2:09 PM
Dates	Participating Approval Date	Update	New Registration		5/6/2025 2:09:00 PM	5/6/2025 2:09 PM
Details	State	Update	New Registration	Pending	Approved	5/6/2025 2:09 PM
Dates	Signed By Date	Update	New Registration		4/10/2025 4:44:51 PM	5/6/2025 2:09 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	5/6/2025 2:09 PM
Medicaid Billing	Medicaid: Number	Delete	New Registration	1427110329 (CA)		4/10/2025 4:44 PM
Contacts	Primary Contact	Update	Profile Change Request	Pilot, Erin Chief Financial Officer Livingston Community Health 2098501362	Pilot, Erin Chief Financial Officer Livingston Community Health 2098503500-1362	4/8/2025 6:32 PM
Addresses	Main Address	Insert	New Registration		1444 Florida Ave, Suite 202 Modesto, CA 95350-4400	4/8/2025 6:13 PM
Addresses	Billing Address	Insert	New Registration		Livingston Community Health 600 B Street, Bldg A Livingston, CA 95334	4/8/2025 6:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	4/8/2025 6:13 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		1427110329	4/8/2025 6:13 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		CA	4/8/2025 6:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1427110329	4/8/2025 6:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/8/2025 6:13 PM
Contacts	Authorizing Official	Insert	New Registration		Abasta-Cummings, Leslie Chief Executive Officer Livingston Community Health 2098503545	4/8/2025 6:13 PM
Contacts	Primary Contact	Insert	New Registration		Pilot, Erin Chief Financial Officer Livingston Community Health 2098501362	4/8/2025 6:13 PM
Details	Assistance Received From Date	Insert	New Registration			4/8/2025 6:13 PM
Details	Assistance Received To Date	Insert	New Registration			4/8/2025 6:13 PM
Details	Last Recertification Date	Insert	New Registration			4/8/2025 6:13 PM
Details	Grant Number	Insert	New Registration		H80CS02588	4/8/2025 6:13 PM
Details	340B ID	Insert	New Registration			4/8/2025 6:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/8/2025 6:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/8/2025 6:13 PM
Details	Medicare Provider Number	Insert	New Registration			4/8/2025 6:13 PM
Details	Entity Name	Insert	New Registration		LIVINGSTON COMMUNITY HEALTH	4/8/2025 6:13 PM
Details	NOFO Number	Insert	New Registration			4/8/2025 6:13 PM
Details	Program Code	Insert	New Registration		CH	4/8/2025 6:13 PM
Details	Entity Subname	Insert	New Registration		Modesto Health Center - Florida Ave	4/8/2025 6:13 PM
Dates	Participating Approval Date	Insert	New Registration			4/8/2025 6:13 PM
Details	State	Insert	New Registration		Pending	4/8/2025 6:13 PM
Dates	Registration Date	Insert	New Registration		4/8/2025 6:13:24 PM	4/8/2025 6:13 PM
Dates	Signed By Date	Insert	New Registration			4/8/2025 6:13 PM
Dates	Start Date	Insert	New Registration			4/8/2025 6:13 PM
Terminations	Termination Comments	Insert	New Registration			4/8/2025 6:13 PM
Terminations	Termination Date	Insert	New Registration			4/8/2025 6:13 PM
Terminations	Termination Effective Date	Insert	New Registration			4/8/2025 6:13 PM
Terminations	Termination Reason	Insert	New Registration			4/8/2025 6:13 PM

340B Drug Pricing Program Database