| Medicaid Billing | NPI: Number | Delete | Recertification | 1730490194 (CA) | | 2/20/2025 5:03 PM |
| Details | Last Recertification Date | Update | Recertification | | 2/20/2025 5:03:20 PM | 2/20/2025 5:03 PM |
| Addresses | Main Address | Update | Change Request |
18550 DePaul Drive, #103, 104, 109, 120, 130, 140, 150, 202, 205-208
Morgan Hill, CA 95037-2911 |
18550 DePaul Drive #103,104,109,120,130,140,150,202,203,205-208
Morgan Hill, CA 95037-2911 | 10/22/2024 12:58 PM |
| Addresses | Shipping Address | Insert | Change Request | | Valley Health Center at North County Pharmacy
4151 Middlefield Rd #300
Palo Alto, CA 94303 | 10/22/2024 12:58 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1326873795 | 10/22/2024 12:58 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | CA | 10/22/2024 12:58 PM |
| Details | State | Update | | Approved | Active | 7/1/2024 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Singh, Narinder
Director of Pharmacy
SCVMC
4088852300 | 6/3/2024 12:50 PM |
| Details | 340B ID | Update | New Registration | | CH091181AP | 6/3/2024 12:50 PM |
| Dates | Participating Approval Date | Update | New Registration | | 6/3/2024 12:50:22 PM | 6/3/2024 12:50 PM |
| Details | State | Update | New Registration | Pending | Approved | 6/3/2024 12:50 PM |
| Dates | Signed By Date | Update | New Registration | | 4/15/2024 1:56:29 PM | 6/3/2024 12:50 PM |
| Dates | Start Date | Update | New Registration | | 7/1/2024 12:00:00 AM | 6/3/2024 12:50 PM |
| Addresses | Main Address | Insert | New Registration | |
18550 DePaul Drive, #103, 104, 109, 120, 130, 140, 150, 202, 205-208
Morgan Hill, CA 95037-2911 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Enborg Lane Pharmacy
2221 Enborg Lane
1J018
San Jose, CA 95128 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | O'Connor Out-Patient Pharmacy
2101 Forest Ave Suite 122
San Jose, CA 95128-1424 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Santa Clara County Public VHC at Lenzen Pharmacy
976 Lenzen Avenue
San Jose, CA 95126 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Santa Clara Valley Medical Center Outpatient Pharmacy
751 S Bascom Ave. Ste 150
San Jose, CA 95128-2604 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | SCVH&HS Refill Ctr Pharmacy
871 Enborg Court Unit 200
San Jose, CA 95128 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center @ Gilroy Pharmacy
7475 Camino Arroyo Suite 1025
Gilroy, CA 95020-7340 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center at Downtown Pharmacy
777 E. Santa Clara St
San Jose, CA 95112-1909 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center at Sunnyvale Pharmacy
660 South Fair Oaks Avenue Suite 1057
Sunnyvale, CA 94086 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC @ Milpitas Pharmacy
143 N Main St Suite 1038
Milpitas, CA 95035-4322 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center at San Jose Pharmacy
750 South Bascom Ave
San Jose, CA 95128 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC at East Valley Pharmacy
1993 Mckee Rd
San Jose, CA 95116 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC at Moorpark Pharmacy
2400 Moorpark Avenue Suite 101
San Jose, CA 95128 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC at Tully Pharmacy
500 Tully Road
San Jose, CA 95111 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Santa Clara Valley Medical Center Discharge Pharmacy
751 South Bascom Ave, Main Hospital Building
San Jose, CA 95128-2406 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Santa Clara Valley Health Care Multi-Specialty Clinic Pharmacy
2500 California St Ste D
Mountain View, CA 94040 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center at VASC Pharmacy
2410 Senter Rd Rm 209
San Jose, CA 95111 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center at Lundy Pharmacy
1996 Lundy Ave Ste B
San Jose, CA 95131 | 4/15/2024 12:20 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center at Morgan Hill Pharmacy
18550 De Paul Drive Suite 150
Morgan Hill, CA 95037 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1720136765 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1487286951 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1518045715 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1891871919 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1730490194 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1164507018 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1275992406 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1821241035 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1255417374 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1104904390 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1619053733 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1528144649 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1790863991 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1285081596 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1598418196 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1770238677 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1679261473 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1538864608 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1275393811 | 4/15/2024 12:20 PM |
| Medicaid Billing | NPI: State | Insert | New Registration | | CA | 4/15/2024 12:20 PM |
| Contacts | Primary Contact | Insert | New Registration | | Yoon, Jennefer
Assistant Director of Pharmacy
Santa Clara Valley Health and Hospital System
4088857636 | 4/15/2024 12:20 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Singh, Narinder
Director of Pharmacy
SCVMC
4088852300 | 4/15/2024 12:20 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Details | Grant Number | Insert | New Registration | | H80CS01442 | 4/15/2024 12:20 PM |
| Details | 340B ID | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Details | Entity Name | Insert | New Registration | | COUNTY OF SANTA CLARA | 4/15/2024 12:20 PM |
| Details | NOFO Number | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Details | Program Code | Insert | New Registration | | CH | 4/15/2024 12:20 PM |
| Details | Entity Subname | Insert | New Registration | | Valley Health Center - Morgan Hill | 4/15/2024 12:20 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Details | State | Insert | New Registration | | Pending | 4/15/2024 12:20 PM |
| Dates | Registration Date | Insert | New Registration | | 4/15/2024 12:20:43 PM | 4/15/2024 12:20 PM |
| Dates | Signed By Date | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Dates | Start Date | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Terminations | Termination Date | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/15/2024 12:20 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/15/2024 12:20 PM |