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CH091963C LIVINGSTON COMMUNITY HEALTH (Active)
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Main Details
Name
LIVINGSTON COMMUNITY HEALTH
Subdivision Name
Bentley Health Center
Type
HRSA-Funded Health Center
Site ID
BPS-H80-016843
340B ID
CH091963C
Grant Number
H80CS02588
Additional Details
Current Program Status
Active
Registration Date
1/15/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/10/2016
Last Recertification Date
3/3/2025
Contacts
Authorizing Official
Livingston Community Health
Leslie Abasta-Cummings, CEO
(209) 850-3545
Primary Contact
Livingston Community Health
Erin Pilot, Chief Financial Officer
(209) 850-3500 Ext: 1362
Addresses
Street Address
12619 BENTLEY ST
WATERFORD, CA 95386-9011
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
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Verified in EHB that this is a separate clinic from 12633 Bentley St.
01/20/2016
June 2025
June 2025
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