Contract Pharmacy Details

VALE ROAD PHARMACY
CH092880 Lifelong Medical Care

Covered Entity Details

Entity Name

Lifelong Medical Care

Subdivision Name

LIFELONG MEDICAL CARE

Type

HRSA-Funded Health Center

340B ID

CH092880

Entity Address

2344 6th St
Berkeley, CA 94710-2412

Grant Number

H80CS00808

Participating Start Date

9/9/2005

Last Recertification Date

2/13/2025

Pharmacy Details

Pharmacy Name

VALE ROAD PHARMACY

Pharmacy Address

2023 VALE RD STE 101
SAN PABLO, CA 94806-3891

Pharmacy Comments

Contract Details

Approval Date

7/18/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Marty Lynch, CEO
(510) 549-5450 Ext: 4123

Contract Pharmacy Representative

Snehaben Patel, Rph/ Managing Member
(510) 232-2377

Signed By Date

7/18/2016