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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09288G Lifelong Medical Care
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Covered Entity Details
Entity Name
Lifelong Medical Care
Subdivision Name
LifeLong Medical Care - Downtown Oakland Clinic
Type
HRSA-Funded Health Center
340B ID
CH09288G
Entity Address
616 16th St
Oakland, CA 94612-1205
Grant Number
H80CS00808
Participating Start Date
9/9/2005
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09957
344 THOMAS L. BERKLEY WAY
OAKLAND, CA 94612
Pharmacy Comments
Contract Details
Approval Date
7/6/2006
Contract Begin Date
7/6/2006
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/19/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
7/3/2006
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