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LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09288E Lifelong Medical Care
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Covered Entity Details
Entity Name
Lifelong Medical Care
Subdivision Name
WEST BERKELEY FAMILY PRACTICE
Type
HRSA-Funded Health Center
340B ID
CH09288E
Entity Address
837 Addison St
BERKELEY, CA 94710-2006
Grant Number
H80CS00808
Participating Start Date
10/1/1997
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
LONGS DRUG STORES CALIFORNIA, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03026
2300 SHATTUCK AVE
BERKELEY, CA 94704
Pharmacy Comments
Contract Details
Approval Date
3/15/2007
Contract Begin Date
3/15/2007
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
3/13/2007
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