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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21193
1757 W SAN CARLOS ST
SAN JOSE, CA 95128
Pharmacy Comments
Contract Details
Approval Date
4/10/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Vliet, CEO
(510) 981-4123
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2024
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