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CH09288Z LIFELONG MEDICAL CARE (Terminated)
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Main Details
Name
LIFELONG MEDICAL CARE
Subdivision Name
Hamilton Apartments - Supportive Housing Program
Type
HRSA-Funded Health Center
Site ID
BPS-H80-014320
340B ID
CH09288Z
Grant Number
H80CS00808
Additional Details
Current Program Status
Terminated
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/23/2015
Last Recertification Date
2/12/2021
Termination Date
Termination Reason
4/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
LifeLong Medical Care
David Vliet, CEO
(510) 981-4123
Primary Contact
Lifelong Medical Care
Ka Tung Hui, Pharmacy director
(510) 981-3248
Addresses
Street Address
510 21ST ST
OAKLAND, CA 94612-1693
Billing Address
LifeLong Medical Care
PO Box 11247
Berkeley, CA 94712-2247
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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June 2025
June 2025
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