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MIDTOWN PHARMACY PROFESSIONAL CORPORATIO
CH092880 Lifelong Medical Care
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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
MIDTOWN PHARMACY PROFESSIONAL CORPORATIO
Pharmacy Address
2173 HARBOR BAY PARKWAY
ALAMEDA, CA 94502-3019
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Vliet, CEO
(510) 981-4123
Contract Pharmacy Representative
Lifelong Medical Care
Ka Tung Hui, Pharmacy director
(510) 981-3248
Signed By Date
10/12/2021
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