Covered Entity Details

CH091181AR COUNTY OF SANTA CLARA (Approved) - information as of 5/27/2025 4:02:19 PM

Main Details

Name

COUNTY OF SANTA CLARA

Subdivision Name

Medical Mobile Unit #3

Type

HRSA-Funded Health Center

Site ID

BPS-H80-039247

340B ID

CH091181AR

Grant Number

H80CS01442

Additional Details

Current Program Status

Approved

Registration Date

4/11/2025

Participating Start Date

7/1/2025

Participating Approval Date

4/24/2025

Last Recertification Date

Contacts

Authorizing Official

SCVMC
Narinder Singh, Director of Pharmacy
(408) 885-2300

Primary Contact

Santa Clara Valley Health and Hospital System
Jennefer Yoon, Assistant Director of Pharmacy
(408) 885-7636

Addresses

Street Address

777 E Santa Clara St
San Jose, CA 95112-1934

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
CA		1720136765,1487286951,1518045715,1891871919,1730490194,1164507018,1275992406,1821241035,1255417374,1104904390,1619053733,1528144649,1790863991,1285081596,1598418196,1770238677,1679261473,1538864608,1326873795,1629301346

Shipping Addresses

Shipping Address 1

Enborg Lane Pharmacy
2221 Enborg Lane
1J018
San Jose, CA 95128

Shipping Address 2

O'Connor Out-Patient Pharmacy
2101 Forest Ave Suite 122
San Jose, CA 95128-1424

Shipping Address 3

Santa Clara County Public VHC at Lenzen Pharmacy
976 Lenzen Avenue
San Jose, CA 95126

Shipping Address 4

Santa Clara Valley Medical Center Outpatient Pharmacy
751 S Bascom Ave. Ste 150
San Jose, CA 95128-2604

Shipping Address 5

SCVH&HS Refill Ctr Pharmacy
871 Enborg Court Unit 200
San Jose, CA 95128

Shipping Address 6

Valley Health Center @ Gilroy Pharmacy
7475 Camino Arroyo Suite 1025
Gilroy, CA 95020-7340

Shipping Address 7

Valley Health Center at Downtown Pharmacy
777 E. Santa Clara St
San Jose, CA 95112-1909

Shipping Address 8

Valley Health Center at Sunnyvale Pharmacy
660 South Fair Oaks Avenue Suite 1057
Sunnyvale, CA 94086

Shipping Address 9

VHC @ Milpitas Pharmacy
143 N Main St Suite 1038
Milpitas, CA 95035-4322

Shipping Address 10

Valley Health Center at San Jose Pharmacy
750 South Bascom Ave
San Jose, CA 95128

Shipping Address 11

VHC at East Valley Pharmacy
1993 Mckee Rd
San Jose, CA 95116

Shipping Address 12

VHC at Moorpark Pharmacy
2400 Moorpark Avenue Suite 101
San Jose, CA 95128

Shipping Address 13

VHC at Tully Pharmacy
500 Tully Road
San Jose, CA 95111

Shipping Address 14

Santa Clara Valley Medical Center Discharge Pharmacy
751 South Bascom Ave, Main Hospital Building
San Jose, CA 95128-2406

Shipping Address 15

Santa Clara Valley Health Care Multi-Specialty Clinic Pharmacy
2500 California St Ste D
Mountain View, CA 94040

Shipping Address 16

Valley Health Center at VASC Pharmacy
2410 Senter Rd Rm 209
San Jose, CA 95111

Shipping Address 17

Valley Health Center at Lundy Pharmacy
1996 Lundy Ave Ste B
San Jose, CA 95131

Shipping Address 18

Valley Health Center at Morgan Hill Pharmacy
18550 De Paul Drive, Suite 150
Morgan Hill, CA 95037

Shipping Address 19

Valley Health Center at North County Pharmacy
4151 Middlefield Rd #300
Palo Alto, CA 94303

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH091181A	Active	BPS-H80-001250	SANTA CLARA, COUNTY OF	Valley Health Center East Valley	1993 Mckee Rd		San Jose	CA
CH091181AA	Terminated	BPS-H80-018234	SANTA CLARA, COUNTY OF	Valley Health Center Lenzen	976 Lenzen Ave, Basement		San Jose	CA
CH091181AB	Active	BPS-H80-018237	SANTA CLARA, COUNTY OF	VHC Moorpark -Internal Medicine	2400 Moorpark Ave Ste 204		San Jose	CA
CH091181AC	Active	BPS-H80-018242	SANTA CLARA, COUNTY OF	VHC Moorpark-Internal Medicine	2400 Moorpark Ave Ste 212		San Jose	CA
CH091181AD	Active	BPS-H80-027555	SANTA CLARA, COUNTY OF	Hope Clinic	725 E Santa Clara St Ste 300		San Jose	CA
CH091181AE	Active	BPS-H80-030924	SANTA CLARA, COUNTY OF	O'Connor Medical Clinic Hospital Campus	2101 Forest Ave		San Jose	CA
CH091181AF	Active	BPS-H80-030736	SANTA CLARA, COUNTY OF	Santa Clara Valley Dentalcare - Mountain View El Camino Real	2486 W El Camino Real		Mountain View	CA
CH091181AG	Active	BPS-H80-031134	SANTA CLARA, COUNTY OF	O'Connor Medical Clinic Forest #103	2100 Forest Ave Ste 103		San Jose	CA
CH091181AH	Active	BPS-H80-034024	SANTA CLARA, COUNTY OF	Valley Health Center - Vietnamese American Service Center (VASC)	2410 Senter Road, #205, #206, #209, #215, #223-229, #231-237 & #246		San Jose	CA
CH091181AJ	Active	BPS-H80-032277	SANTA CLARA, COUNTY OF	O'Connor Medical Clinic Forest #104	2100 Forest Ave Ste 104		San Jose	CA
CH091181AK	Active	BPS-H80-035954	SANTA CLARA, COUNTY OF	Youth Health Center - PDSC	455 O'Connor Drive STE 300		San Jose	CA
CH091181AL	Active	BPS-H80-037315	SANTA CLARA, COUNTY OF	Valley Health Center Lundy	1996 Lundy Ave		San Jose	CA
CH091181AM	Active	BPS-H80-037827	SANTA CLARA, COUNTY OF	Youth Health Center SPARK	455 O'Connor Drive STE 350		San Jose	CA
CH091181AN	Active	BPS-H80-038383	SANTA CLARA, COUNTY OF	Reentry Mobile Medical Unit #4	725 E Santa Clara St		San Jose	CA
CH091181AP	Active	BPS-H80-038482	COUNTY OF SANTA CLARA	Valley Health Center - Morgan Hill	18550 DePaul Drive #103,104,109,120,130,140,150,202,203,205-208		Morgan Hill	CA
CH091181AQ	Active	BPS-H80-038577	COUNTY OF SANTA CLARA	Valley Health Center - North County	4151 Middlefield Rd		Palo Alto	CA
CH091181AR	Approved	BPS-H80-039247	COUNTY OF SANTA CLARA	Medical Mobile Unit #3	777 E Santa Clara St		San Jose	CA
CH091181AS	Approved	BPS-H80-039553	COUNTY OF SANTA CLARA	Medical Clinic at Reentry Resource Center San Jose	151 W. Mission Street STE C1.01		San Jose	CA
CH091181B	Active	BPS-H80-002441	SANTA CLARA, COUNTY OF	Valley Health Center Tully	500 Tully Rd		San Jose	CA
CH091181C	Active	BPS-H80-007636	SANTA CLARA, COUNTY OF	Valley Health Center Gilroy	7475 Camino Arroyo		Gilroy	CA
CH091181D	Active	BPS-H80-010255	SANTA CLARA, COUNTY OF	Valley Health Center Milpitas	143 N. Main Street		Milpitas	CA
CH091181H	Active	BPS-H80-001765	SANTA CLARA, COUNTY OF	Valley Health Center San Jose	750 S. BASCOM AVE		SAN JOSE	CA
CH091181K	Active	BPS-H80-018240	SANTA CLARA, COUNTY OF	VHC Moorpark- Internal Medicine	2400 Moorpark Ave Ste 220		San Jose	CA
CH091181L	Terminated	BPS-H80-000680	SANTA CLARA, COUNTY OF	Valley Health Center Lenzen	976 Lenzen Ave	Suite 1500B	San Jose	CA
CH091181M	Active	BPS-H80-000340	SANTA CLARA, COUNTY OF	Valley Health Center Sunnyvale	660 S. Fair Oaks Ave,	First Floor and Second Floor	Sunnyvale	CA
CH091181N	Active	BPS-H80-000394	SANTA CLARA, COUNTY OF	Medical Mobile Unit Teen Van #2	660 S. Fair Oaks Ave FL 1 and 2		Sunnyvale	CA
CH091181P	Terminated	BPS-H80-001732	SANTA CLARA, COUNTY OF	HOMELESS DENTAL MOBILE UNIT	500 Tully Rd		San Jose	CA
CH091181Q	Active	BPS-H80-004064	SANTA CLARA, COUNTY OF	Medical Mobile Unit #1	2101 Alexian Avenue STE D		San Jose	CA
CH091181R	Active	BPS-H80-001606	SANTA CLARA, COUNTY OF	Homeless Clinic at HomeFirst Shelter	2011 Little Orchard St,		San Jose	CA
CH091181T	Active	BPS-H80-003574	SANTA CLARA, COUNTY OF	Dental Mobile Unit #5	660 South Fair Oaks Avenue	First Floor and Second FL	Sunnyvale	CA
CH091181U	Active	BPS-H80-009626	SANTA CLARA, COUNTY OF	Valley Health Center Alexian	2101 Alexian Drive Ste D		San Jose	CA
CH091181V	Active	BPS-H80-018244	SANTA CLARA, COUNTY OF	Valley Health Center Downtown	777 E Santa Clara St		San Jose	CA
CH091181W	Active	BPS-H80-018243	SANTA CLARA, COUNTY OF	VHC Moorpark Urgent Care	2400 Moorpark Ave Ste 118		San Jose	CA
CH091181X	Active	BPS-H80-018236	SANTA CLARA, COUNTY OF	VHC Moorpark-Maternal Fetal Medicine	2400 Moorpark Ave Ste 100		San Jose	CA
CH091181Y	Active	BPS-H80-018241	SANTA CLARA, COUNTY OF	VHC Moorpark - Lab	2400 Moorpark Ave Ste 105		San Jose	CA
CH091181Z	Active	BPS-H80-018238	SANTA CLARA, COUNTY OF	VHC Moorpark - Diagnostic Imaging	2400 Moorpark Ave Ste 214		San Jose	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH091181H	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181B	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181D	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181A	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	05/01/2010	05/02/2018
CH091181C	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181K	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	05/01/2010	05/30/2018
CH091181L	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181M	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181U	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181T	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181R	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181Q	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181P	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2014	04/01/2018
CH091181N	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181V	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181H	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	05/01/2010	06/06/2018
CH091181B	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	05/01/2010	06/06/2018
CH091181D	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	05/01/2010	06/06/2018
CH091181A	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	05/01/2010	05/02/2018
CH091181C	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	05/01/2010	06/06/2018
CH091181K	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	05/01/2010	05/30/2018
CH091181L	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	05/01/2010	06/06/2018
CH091181M	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	05/01/2010	06/06/2018
CH091181U	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2014	06/06/2018
CH091181T	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2014	06/06/2018
CH091181R	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2014	06/06/2018
CH091181Q	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2014	06/06/2018
CH091181P	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2014	04/01/2018
CH091181N	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2014	06/06/2018
CH091181V	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	10/01/2016	06/06/2018
CH091181H	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181B	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181D	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181A	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	05/02/2018
CH091181C	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181K	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	05/30/2018
CH091181L	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181M	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181U	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181T	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181R	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181Q	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181P	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	04/01/2018
CH091181N	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181V	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	10/01/2016	06/06/2018
CH091181H	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181B	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181D	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181A	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	05/01/2010	05/02/2018
CH091181C	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181K	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	05/01/2010	05/30/2018
CH091181L	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181M	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	05/01/2010	06/06/2018
CH091181U	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181T	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181R	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181Q	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181P	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2014	04/01/2018
CH091181N	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2014	06/06/2018
CH091181V	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	10/01/2016	06/06/2018

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Signed By	Insert	New Registration		Singh, Narinder Director of Pharmacy SCVMC 4088852300	4/24/2025 2:06 PM
Details	340B ID	Update	New Registration		CH091181AR	4/24/2025 2:06 PM
Dates	Participating Approval Date	Update	New Registration		4/24/2025 2:06:56 PM	4/24/2025 2:06 PM
Details	State	Update	New Registration	Pending	Approved	4/24/2025 2:06 PM
Dates	Signed By Date	Update	New Registration		4/11/2025 7:00:31 PM	4/24/2025 2:06 PM
Dates	Start Date	Update	New Registration		7/1/2025 12:00:00 AM	4/24/2025 2:06 PM
Addresses	Main Address	Insert	New Registration		777 E Santa Clara St San Jose, CA 95112-1934	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Enborg Lane Pharmacy 2221 Enborg Lane 1J018 San Jose, CA 95128	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		O'Connor Out-Patient Pharmacy 2101 Forest Ave Suite 122 San Jose, CA 95128-1424	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Santa Clara County Public VHC at Lenzen Pharmacy 976 Lenzen Avenue San Jose, CA 95126	4/11/2025 5:47 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	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		SCVH&HS Refill Ctr Pharmacy 871 Enborg Court Unit 200 San Jose, CA 95128	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Valley Health Center @ Gilroy Pharmacy 7475 Camino Arroyo Suite 1025 Gilroy, CA 95020-7340	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Valley Health Center at Downtown Pharmacy 777 E. Santa Clara St San Jose, CA 95112-1909	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Valley Health Center at Sunnyvale Pharmacy 660 South Fair Oaks Avenue Suite 1057 Sunnyvale, CA 94086	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		VHC @ Milpitas Pharmacy 143 N Main St Suite 1038 Milpitas, CA 95035-4322	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Valley Health Center at San Jose Pharmacy 750 South Bascom Ave San Jose, CA 95128	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		VHC at East Valley Pharmacy 1993 Mckee Rd San Jose, CA 95116	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		VHC at Moorpark Pharmacy 2400 Moorpark Avenue Suite 101 San Jose, CA 95128	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		VHC at Tully Pharmacy 500 Tully Road San Jose, CA 95111	4/11/2025 5:47 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	4/11/2025 5:47 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	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Valley Health Center at VASC Pharmacy 2410 Senter Rd Rm 209 San Jose, CA 95111	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Valley Health Center at Lundy Pharmacy 1996 Lundy Ave Ste B San Jose, CA 95131	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Valley Health Center at Morgan Hill Pharmacy 18550 De Paul Drive, Suite 150 Morgan Hill, CA 95037	4/11/2025 5:47 PM
Addresses	Shipping Address	Insert	New Registration		Valley Health Center at North County Pharmacy 4151 Middlefield Rd #300 Palo Alto, CA 94303	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1720136765	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1487286951	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1518045715	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1891871919	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1730490194	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1164507018	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1275992406	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1821241035	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1255417374	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1104904390	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1619053733	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1528144649	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1790863991	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1285081596	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1598418196	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1770238677	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1679261473	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1538864608	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1326873795	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1629301346	4/11/2025 5:47 PM
Medicaid Billing	NPI: State	Insert	New Registration		CA	4/11/2025 5:47 PM
Contacts	Primary Contact	Insert	New Registration		Yoon, Jennefer Assistant Director of Pharmacy Santa Clara Valley Health and Hospital System 4088857636	4/11/2025 5:47 PM
Contacts	Authorizing Official	Insert	New Registration		Singh, Narinder Director of Pharmacy SCVMC 4088852300	4/11/2025 5:47 PM
Details	Assistance Received From Date	Insert	New Registration			4/11/2025 5:47 PM
Details	Assistance Received To Date	Insert	New Registration			4/11/2025 5:47 PM
Details	Last Recertification Date	Insert	New Registration			4/11/2025 5:47 PM
Details	Grant Number	Insert	New Registration		H80CS01442	4/11/2025 5:47 PM
Details	340B ID	Insert	New Registration			4/11/2025 5:47 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			4/11/2025 5:47 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			4/11/2025 5:47 PM
Details	Medicare Provider Number	Insert	New Registration			4/11/2025 5:47 PM
Details	Entity Name	Insert	New Registration		COUNTY OF SANTA CLARA	4/11/2025 5:47 PM
Details	NOFO Number	Insert	New Registration			4/11/2025 5:47 PM
Details	Program Code	Insert	New Registration		CH	4/11/2025 5:47 PM
Details	Entity Subname	Insert	New Registration		Medical Mobile Unit #3	4/11/2025 5:47 PM
Dates	Participating Approval Date	Insert	New Registration			4/11/2025 5:47 PM
Details	State	Insert	New Registration		Pending	4/11/2025 5:47 PM
Dates	Registration Date	Insert	New Registration		4/11/2025 5:47:00 PM	4/11/2025 5:47 PM
Dates	Signed By Date	Insert	New Registration			4/11/2025 5:47 PM
Dates	Start Date	Insert	New Registration			4/11/2025 5:47 PM
Terminations	Termination Comments	Insert	New Registration			4/11/2025 5:47 PM
Terminations	Termination Date	Insert	New Registration			4/11/2025 5:47 PM
Terminations	Termination Effective Date	Insert	New Registration			4/11/2025 5:47 PM
Terminations	Termination Reason	Insert	New Registration			4/11/2025 5:47 PM

340B Drug Pricing Program Database