Covered Entity Details

CH09021S GARDNER FAMILY HEALTH NETWORK, INC. (Terminated) - information as of 4/25/2025 8:34:42 PM

Main Details

Name

GARDNER FAMILY HEALTH NETWORK, INC.

Subdivision Name

Healthcare to the Homeless

Type

HRSA-Funded Health Center

Site ID

BPS-H80-001044

340B ID

CH09021S

Grant Number

H80CS00359

Additional Details

Current Program Status

Terminated

Registration Date

1/14/2013

Participating Start Date

4/1/2013

Participating Approval Date

2/25/2013

Last Recertification Date

1/27/2020

Termination Date
Termination Reason

4/1/2020
Site closure

Contacts

Authorizing Official

Gardner Family Health Network, Inc.
EFRAIN CORIA, CHIEF OPERATIONS OFFICER
(408) 200-2291

Primary Contact

Gardner Family Health Network, Inc.
Helen Tong, Director of Pharmacy
(408) 918-2613

Addresses

Street Address

1621 GOLD STREET
ALVISO, CA 95002

Billing Address

GARDNER FAMILY HEALTH NETWORK, INC.
1621 GOLD ST PO BOX 1240
ALVISO, CA 95002

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
		1164552931,1952479602,1821239112

Shipping Addresses

Shipping Address 1

GARDNER FAMILY HEALTH NETWORK INC
GARDNER SOUTH COUNTY HEALTH CENTER PHARMACY
7526 MONTEREY ST
GILROY, CA 95020

Shipping Address 2

GARDNER FAMILY HEALTH NETWORK, INC.
ST JAMES HEALTH CENTER PHARMACY
55 E JULIAN ST
SAN JOSE, CA 95112

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	City	State
CH090210	Active	BPS-H80-004836	GARDNER FAMILY HEALTH NETWORK, INC	Alviso Health Center	1621 GOLD ST	ALVISO	CA
CH09021A	Active	BPS-H80-005308	Gardner Family Health Network, Inc.	GARDNER HEALTH CENTER	195 E Virginia St	San Jose	CA
CH09021AA	Active	BPS-H80-027779	Gardner Family Health Network, Inc.	Gardner Specialty Service Center	160 E Virginia St	San Jose	CA
CH09021E	Active	BPS-H80-000989	Gardner Family Health Network, Inc.	ST. JAMES HEALTH CENTER	55 E Julian St	San Jose	CA
CH09021F	Active	BPS-H80-002042	Gardner Family Health Network, Inc.	COMPRECARE HEALTH CENTER	3030 ALUM ROCK AVE	SAN JOSE	CA
CH09021P	Active	BPS-H80-001936	Gardner Family Health Network, Inc.	GARDNER SOUTH COUNTY HEALTH CTR	7526 Monterey St	Gilroy	CA
CH09021Q	Active	BPS-H80-011063	Gardner Family Health Network, Inc.	Gardner Downtown Health Center	725 E Santa Clara St	San Jose	CA
CH09021S	Terminated	BPS-H80-001044	GARDNER FAMILY HEALTH NETWORK, INC.	Healthcare to the Homeless	1621 GOLD STREET	ALVISO	CA
CH09021T	Active	BPS-H80-006554	GARDNER FAMILY HEALTH NETWORK, INC.	MOBILE UNIT 2	1621 GOLD ST	ALVISO	CA
CH09021U	Active	BPS-H80-007300	GARDNER FAMILY HEALTH NETWORK, INC.	BILL WILSON CENTER	3490 THE ALAMEDA	SANTA CLARA	CA
CH09021V	Active	BPS-H80-006379	GARDNER FAMILY HEALTH NETWORK, INC.	CITY TEAM MINISTRIES	580 CHARLES ST	SAN JOSE	CA
CH09021W	Active	BPS-H80-006477	GARDNER FAMILY HEALTH NETWORK, INC.	MOBILE UNIT 1 CLINIC	1621 Gold Street	Alviso	CA
CH09021X	Active	BPS-H80-027553	GARDNER FAMILY HEALTH NETWORK, INC.	JOHN XXIII HEALTH CENTER	195 E. SAN FERNANDO ST., STE 100	SAN JOSE	CA
CH09021Y	Active	BPS-H80-014013	GARDNER FAMILY HEALTH NETWORK, INC.	Gardner Packard Children's Health Center	3351 EL CAMINO REAL	ATHERTON	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH09021E	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2013
CH090210	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2013
CH09021F	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2013
CH09021P	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2013
CH09021A	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2013
CH09021Q	ENBORG LANE PHARMACY	2221 ENBORG LANE	1J018	SAN JOSE	CA	95128	04/01/2013
CH090210	O'CONNOR OUT-PATIENT PHARMACY	2101 Forest Ave Suite 122		San Jose	CA	95128-1424	07/01/2022
CH09021E	SANTA CLARA COUNTY PUBLIC	VHC AT LENZEN PHARMACY	976 LENZEN AVENUE	SAN JOSE	CA	95126	04/01/2013
CH090210	SANTA CLARA COUNTY PUBLIC	VHC AT LENZEN PHARMACY	976 LENZEN AVENUE	SAN JOSE	CA	95126	04/01/2013
CH09021F	SANTA CLARA COUNTY PUBLIC	VHC AT LENZEN PHARMACY	976 LENZEN AVENUE	SAN JOSE	CA	95126	04/01/2013
CH09021P	SANTA CLARA COUNTY PUBLIC	VHC AT LENZEN PHARMACY	976 LENZEN AVENUE	SAN JOSE	CA	95126	04/01/2013
CH09021A	SANTA CLARA COUNTY PUBLIC	VHC AT LENZEN PHARMACY	976 LENZEN AVENUE	SAN JOSE	CA	95126	04/01/2013
CH09021Q	SANTA CLARA COUNTY PUBLIC	VHC AT LENZEN PHARMACY	976 LENZEN AVENUE	SAN JOSE	CA	95126	04/01/2013
CH090210	SANTA CLARA VALLEY HEALTH CARE MULTI-SPE	CLINIC PHARMACY	2500 CALIFORNIA ST STE D	MOUNTAIN VIEW	CA	94040	07/01/2022
CH09021E	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2013
CH090210	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2013
CH09021F	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2013
CH09021P	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2013
CH09021A	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2013
CH09021Q	SANTA CLARA VALLEY MEDICAL	CENTER OUTPATIENT PHARMACY	751 S BASCOM AVE STE 150	SAN JOSE	CA	95128-2604	04/01/2013
CH090210	SANTA CLARA VALLEY MEDICAL CENTER	DISCHARGE PHARMACY	751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL	SAN JOSE	CA	95128	07/01/2022
CH09021E	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2013
CH090210	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2013
CH09021F	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2013
CH09021P	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2013
CH09021A	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2013
CH09021Q	SCVH&HS REFILL CTR PHARMACY	871 ENBORG COURT	UNIT 200	SAN JOSE	CA	95128	04/01/2013
CH09021E	VALLEY HEALTH CENTER @ GILROY PHARMACY	7475 CAMINO ARROYO	SUITE 1025	GILROY	CA	95020-7340	04/01/2013
CH090210	VALLEY HEALTH CENTER @ GILROY PHARMACY	7475 CAMINO ARROYO	SUITE 1025	GILROY	CA	95020-7340	04/01/2013
CH09021F	VALLEY HEALTH CENTER @ GILROY PHARMACY	7475 CAMINO ARROYO	SUITE 1025	GILROY	CA	95020-7340	04/01/2013
CH09021P	VALLEY HEALTH CENTER @ GILROY PHARMACY	7475 CAMINO ARROYO	SUITE 1025	GILROY	CA	95020-7340	04/01/2013
CH09021A	VALLEY HEALTH CENTER @ GILROY PHARMACY	7475 CAMINO ARROYO	SUITE 1025	GILROY	CA	95020-7340	04/01/2013
CH09021Q	VALLEY HEALTH CENTER @ GILROY PHARMACY	7475 CAMINO ARROYO	SUITE 1025	GILROY	CA	95020-7340	04/01/2013
CH090210	VALLEY HEALTH CENTER AT DOWNTOWN	PHARMACY	777 E. SANTA CLARA ST	SAN JOSE	CA	95112-1909	10/01/2018
CH09021P	VALLEY HEALTH CENTER AT DOWNTOWN	PHARMACY	777 E. SANTA CLARA ST	SAN JOSE	CA	95112-1909	10/01/2019
CH09021F	VALLEY HEALTH CENTER AT DOWNTOWN	PHARMACY	777 E. SANTA CLARA ST	SAN JOSE	CA	95112-1909	10/01/2019
CH09021A	VALLEY HEALTH CENTER AT DOWNTOWN	PHARMACY	777 E. SANTA CLARA ST	SAN JOSE	CA	95112-1909	10/01/2019
CH09021Q	VALLEY HEALTH CENTER AT DOWNTOWN	PHARMACY	777 E. SANTA CLARA ST	SAN JOSE	CA	95112-1909	10/01/2019
CH09021E	VALLEY HEALTH CENTER AT DOWNTOWN	PHARMACY	777 E. SANTA CLARA ST	SAN JOSE	CA	95112-1909	10/01/2019
CH090210	VALLEY HEALTH CENTER AT LUNDY PHARMACY	1996 LUNDY AVE STE B		SAN JOSE	CA	95131	01/01/2024
CH090210	VALLEY HEALTH CENTER AT MORGAN HILL PHAR	18550 DEPAUL DRIVE SUITE 150		MORGAN HILL	CA	95037	01/01/2024
CH090210	VALLEY HEALTH CENTER AT NORTH COUNTY PHA	4151 MIDDLEFIELD RD #300		PALO ALTO	CA	94303	07/01/2025
CH09021E	VALLEY HEALTH CENTER AT SAN JOSE PHARMAC	750 SOUTH BASCOM AVE		SAN JOSE	CA	95128	04/01/2013
CH090210	VALLEY HEALTH CENTER AT SAN JOSE PHARMAC	750 SOUTH BASCOM AVE		SAN JOSE	CA	95128	04/01/2013
CH09021F	VALLEY HEALTH CENTER AT SAN JOSE PHARMAC	750 SOUTH BASCOM AVE		SAN JOSE	CA	95128	04/01/2013
CH09021P	VALLEY HEALTH CENTER AT SAN JOSE PHARMAC	750 SOUTH BASCOM AVE		SAN JOSE	CA	95128	04/01/2013
CH09021A	VALLEY HEALTH CENTER AT SAN JOSE PHARMAC	750 SOUTH BASCOM AVE		SAN JOSE	CA	95128	04/01/2013
CH09021Q	VALLEY HEALTH CENTER AT SAN JOSE PHARMAC	750 SOUTH BASCOM AVE		SAN JOSE	CA	95128	04/01/2013
CH09021E	VALLEY HEALTH CENTER AT SUNNYVALE PHARMA	660 SOUTH FAIR OAKS AVENUE	SUITE 1057	SUNNYVALE	CA	94086	04/01/2013
CH090210	VALLEY HEALTH CENTER AT SUNNYVALE PHARMA	660 SOUTH FAIR OAKS AVENUE	SUITE 1057	SUNNYVALE	CA	94086	04/01/2013
CH09021F	VALLEY HEALTH CENTER AT SUNNYVALE PHARMA	660 SOUTH FAIR OAKS AVENUE	SUITE 1057	SUNNYVALE	CA	94086	04/01/2013
CH09021P	VALLEY HEALTH CENTER AT SUNNYVALE PHARMA	660 SOUTH FAIR OAKS AVENUE	SUITE 1057	SUNNYVALE	CA	94086	04/01/2013
CH09021A	VALLEY HEALTH CENTER AT SUNNYVALE PHARMA	660 SOUTH FAIR OAKS AVENUE	SUITE 1057	SUNNYVALE	CA	94086	04/01/2013
CH09021Q	VALLEY HEALTH CENTER AT SUNNYVALE PHARMA	660 SOUTH FAIR OAKS AVENUE	SUITE 1057	SUNNYVALE	CA	94086	04/01/2013
CH090210	VALLEY HEALTH CENTER AT VASC PHARMACY	2410 Senter Rd Rm 209		San Jose	CA	95111	07/01/2022
CH09021E	VHC @ MILPITAS PHARMACY	143 N MAIN ST	SUITE 1038	MILPITAS	CA	95035-4322	04/01/2013
CH090210	VHC @ MILPITAS PHARMACY	143 N MAIN ST	SUITE 1038	MILPITAS	CA	95035-4322	04/01/2013
CH09021F	VHC @ MILPITAS PHARMACY	143 N MAIN ST	SUITE 1038	MILPITAS	CA	95035-4322	04/01/2013
CH09021P	VHC @ MILPITAS PHARMACY	143 N MAIN ST	SUITE 1038	MILPITAS	CA	95035-4322	04/01/2013
CH09021A	VHC @ MILPITAS PHARMACY	143 N MAIN ST	SUITE 1038	MILPITAS	CA	95035-4322	04/01/2013
CH09021Q	VHC @ MILPITAS PHARMACY	143 N MAIN ST	SUITE 1038	MILPITAS	CA	95035-4322	04/01/2013
CH09021E	VHC AT EAST VALLEY PHARMACY	1993 MCKEE RD		SAN JOSE	CA	95116	04/01/2013
CH090210	VHC AT EAST VALLEY PHARMACY	1993 MCKEE RD		SAN JOSE	CA	95116	04/01/2013
CH09021F	VHC AT EAST VALLEY PHARMACY	1993 MCKEE RD		SAN JOSE	CA	95116	04/01/2013
CH09021P	VHC AT EAST VALLEY PHARMACY	1993 MCKEE RD		SAN JOSE	CA	95116	04/01/2013
CH09021A	VHC AT EAST VALLEY PHARMACY	1993 MCKEE RD		SAN JOSE	CA	95116	04/01/2013
CH09021Q	VHC AT EAST VALLEY PHARMACY	1993 MCKEE RD		SAN JOSE	CA	95116	04/01/2013
CH09021E	VHC AT MOORPARK PHARMACY	2400 MOORPARK AVENUE	SUITE 101	SAN JOSE	CA	95128	04/01/2013
CH090210	VHC AT MOORPARK PHARMACY	2400 MOORPARK AVENUE	SUITE 101	SAN JOSE	CA	95128	04/01/2013
CH09021F	VHC AT MOORPARK PHARMACY	2400 MOORPARK AVENUE	SUITE 101	SAN JOSE	CA	95128	04/01/2013
CH09021P	VHC AT MOORPARK PHARMACY	2400 MOORPARK AVENUE	SUITE 101	SAN JOSE	CA	95128	04/01/2013
CH09021A	VHC AT MOORPARK PHARMACY	2400 MOORPARK AVENUE	SUITE 101	SAN JOSE	CA	95128	04/01/2013
CH09021Q	VHC AT MOORPARK PHARMACY	2400 MOORPARK AVENUE	SUITE 101	SAN JOSE	CA	95128	04/01/2013
CH09021E	VHC AT TULLY PHARMACY	500 TULLY ROAD		SAN JOSE	CA	95111	04/01/2013
CH090210	VHC AT TULLY PHARMACY	500 TULLY ROAD		SAN JOSE	CA	95111	04/01/2013
CH09021F	VHC AT TULLY PHARMACY	500 TULLY ROAD		SAN JOSE	CA	95111	04/01/2013
CH09021P	VHC AT TULLY PHARMACY	500 TULLY ROAD		SAN JOSE	CA	95111	04/01/2013
CH09021A	VHC AT TULLY PHARMACY	500 TULLY ROAD		SAN JOSE	CA	95111	04/01/2013
CH09021Q	VHC AT TULLY PHARMACY	500 TULLY ROAD		SAN JOSE	CA	95111	04/01/2013
CH090210	WALGREEN CO.	DBA: WALGREENS # 00689	121 E EL CAMINO REAL	MOUNTAIN VIEW	CA	94040	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 00842	350 N CAPITOL AVE	SAN JOSE	CA	95133	04/01/2014	05/22/2025
CH090210	WALGREEN CO.	DBA: WALGREENS # 00900	2105 MORRILL AVENUE	SAN JOSE	CA	95132	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 01179	1795 E. CAPITOL EXP	SAN JOSE	CA	95121	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 02081	1760 STORY ROAD	SAN JOSE	CA	95122	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 02169	5536 MONTEREY HWY	SAN JOSE	CA	95138	04/01/2014	08/17/2015
CH090210	WALGREEN CO.	DBA: WALGREENS # 02265	1130 BIRD AVE	SAN JOSE	CA	95125	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 02612	200 N WINCHESTER BLVD	SANTA CLARA	CA	95050	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 02660	41400 BLACOW RD	FREMONT	CA	94538	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 02739	440 BLOSSOM HILL	SAN JOSE	CA	95123	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 02957	1660 WINCHESTER BLVD	CAMPBELL	CA	95008	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 03445	2799 S WHITE RD	SAN JOSE	CA	95148	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 03671	342 W CALAVERAS BLVD	MILPITAS	CA	95035	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 03754	1399 W SAN CARLOS	SAN JOSE	CA	95126	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 04372	780 E SANTA CLARA STREET	SAN JOSE	CA	95112	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 04516	745 E DUNNE AVE	MORGAN HILL	CA	95037	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 05219	5 S 1ST STREET	SAN JOSE	CA	95113	04/01/2014	04/05/2018
CH090210	WALGREEN CO.	DBA: WALGREENS # 05454	1661 MCKEE RD	SAN JOSE	CA	95116-1236	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 05480	1833 N. MILPITAS BLVD.	MILPITAS	CA	95035	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 07080	105 E EL CAMINO REAL	SUNNYVALE	CA	94087-1937	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS #09516	770 1ST ST	GILROY	CA	95020	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS #12548	1130 FOXWORTHY AVE.	SAN JOSE	CA	95118	04/01/2014	05/20/2025
CH090210	WALGREEN CO.	DBA: WALGREENS #15246	2140 EL CAMINO REAL	SANTA CLARA	CA	95050	04/01/2014
CH090210	WALGREEN CO.	DBA: WALGREENS # 02126	1414 EL CAMINO REAL	SAN CARLOS	CA	94070	10/01/2018
CH090210	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21141	217 ALMA ST STE 200	PALO ALTO	CA	94301	10/01/2018
CH090210	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #21193	1757 W SAN CARLOS ST	SAN JOSE	CA	95128	01/01/2020
CH090210	WALGREEN CO.	DBA: WALGREENS # 06585	1570 W CAMPBELL AVE	CAMPBELL	CA	95008	01/01/2022
CH090210	WALGREEN CO.	DBA: WALGREENS # 06869	2605 MIDDLEFIELD ROAD	PALO ALTO	CA	94306-2516	01/01/2022
CH090210	WALGREEN CO.	DBA: WALGREENS #13948	1905 W. EL CAMINO REAL	MOUNTAIN VIEW	CA	94040	01/01/2022
CH090210	WALGREEN CO.	DBA: WALGREENS # 07079	1615 MERIDIAN AVE	SAN JOSE	CA	95125-5532	01/01/2022	11/15/2023
CH090210	WALGREEN CO.	DBA: WALGREENS # 02740	3460 EL CAMINO REAL	SANTA CLARA	CA	95051	01/01/2022
CH090210	WALGREEN CO.	DBA: WALGREENS # 02384	2680 UNION AVE	SAN JOSE	CA	95124	04/01/2022
CH090210	WALGREEN CO.	DBA: WALGREENS # 03344	4170 EL CAMINO REAL	PALO ALTO	CA	94306	04/01/2022
CH090210	WALGREEN CO.	DBA: WALGREENS # 00840	1334 SARATOGA AVENUE	SAN JOSE	CA	95129	04/01/2022
CH090210	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	04/01/2014	08/03/2015

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2020 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/22/2020 12:00:00 AM	1/30/2020 9:23 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/30/2020 9:23 AM
Terminations	Termination Date	Update	Termination Request		4/1/2020 12:00:00 AM	1/30/2020 9:23 AM
Terminations	Termination Effective Date	Update	Termination Request		1/23/2020 12:00:00 AM	1/30/2020 9:23 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	1/30/2020 9:23 AM
Details	Last Recertification Date	Update	Recertification	1/29/2019 6:01:20 PM	1/27/2020 3:50:57 PM	1/27/2020 3:50 PM
Details	Last Recertification Date	Update	Recertification	2/7/2018 2:32:25 PM	1/29/2019 6:01:20 PM	1/29/2019 6:01 PM
Details	Last Recertification Date	Update	Recertification	1/26/2017 12:00:00 AM	2/7/2018 2:32:25 PM	2/7/2018 2:32 PM
Contacts	Authorizing Official	Update		CORIA, EFRAIN CHIEF OPERATIONS OFFICER 4082002291	CORIA, EFRAIN CHIEF OPERATIONS OFFICER Gardner Family Health Network, Inc. 4082002291	1/29/2018 1:00 PM
Contacts	Primary Contact	Update		Tong, Helen Director of Pharmacy 4089182613	Tong, Helen Director of Pharmacy Gardner Family Health Network, Inc. 4089182613	9/22/2017 3:08 PM
Addresses	Main Address	Insert			1621 GOLD STREET ALVISO, CA 95002	1/26/2017 3:11 PM
Contacts	Primary Contact	Insert			Tong, Helen Director of Pharmacy 4089182613	1/26/2017 3:11 PM
Contacts	Signed By	Insert			Espinoza, Reymundo C. Chief Executive Officer 4089182682	1/26/2017 3:11 PM
Contacts	Authorizing Official	Insert			CORIA, EFRAIN CHIEF OPERATIONS OFFICER 4082002291	1/26/2017 3:11 PM
Details	Last Recertification Date	Update		2/22/2016 12:00:00 AM	1/26/2017 12:00:00 AM	1/26/2017 3:11 PM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/22/2016 12:00:00 AM	2/22/2016 1:57 PM
Details	Last Recertification Date	Update		2/10/2014 12:00:00 AM	3/4/2015 12:00:00 AM	3/4/2015 12:15 PM
Addresses	Billing Address	Insert			GARDNER FAMILY HEALTH NETWORK, INC. 1621 GOLD ST PO BOX 1240 ALVISO, CA 95002	1/20/2015 7:48 AM
Addresses	Shipping Address	Insert			GARDNER FAMILY HEALTH NETWORK, INC. ST JAMES HEALTH CENTER PHARMACY 55 E JULIAN ST SAN JOSE, CA 95112	1/20/2015 7:48 AM
Addresses	Shipping Address	Insert			GARDNER FAMILY HEALTH NETWORK INC GARDNER SOUTH COUNTY HEALTH CENTER PHARMACY 7526 MONTEREY ST GILROY, CA 95020	1/20/2015 7:48 AM
Details	Last Recertification Date	Update			2/10/2014 12:00:00 AM	2/10/2014 5:50 PM
Details	340B ID	Update		IS-FN-CH09021S	CH09021S	2/25/2013 1:46 PM
Dates	Participating Approval Date	Update			2/25/2013 12:00:00 AM	2/25/2013 1:46 PM
Details	State	Update		Pending	Active	2/25/2013 1:46 PM
Dates	Start Date	Update			4/1/2013 12:00:00 AM	2/25/2013 1:46 PM
Details	340B ID	Update		ONLINE_REG	IS-FN-CH09021S	2/12/2013 4:26 PM
Details	Entity Subname	Update		HEALTHCARE FOR THE HOMELESS	Healthcare to the Homeless	2/12/2013 4:26 PM
Medicaid Billing	NPI: Number	Insert			1164552931	1/14/2013 1:40 PM
Medicaid Billing	NPI: Number	Insert			1952479602	1/14/2013 1:40 PM
Medicaid Billing	NPI: Number	Insert			1821239112	1/14/2013 1:40 PM
Details	Last Recertification Date	Insert				1/14/2013 1:40 PM
Details	Grant Number	Insert			H80CS00359	1/14/2013 1:40 PM
Details	340B ID	Insert			ONLINE_REG	1/14/2013 1:40 PM
Details	Is Authorizing Official EHB Data	Insert				1/14/2013 1:40 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/14/2013 1:40 PM
Details	Medicare Provider Number	Insert				1/14/2013 1:40 PM
Details	Entity Name	Insert			GARDNER FAMILY HEALTH NETWORK, INC.	1/14/2013 1:40 PM
Details	Program Code	Insert			CH	1/14/2013 1:40 PM
Details	Entity Subname	Insert			HEALTHCARE FOR THE HOMELESS	1/14/2013 1:40 PM
Dates	Participating Approval Date	Insert				1/14/2013 1:40 PM
Details	State	Insert			Pending	1/14/2013 1:40 PM
Dates	Registration Date	Insert			1/14/2013 12:00:00 AM	1/14/2013 1:40 PM
Dates	Signed By Date	Insert			1/14/2013 12:00:00 AM	1/14/2013 1:40 PM
Dates	Start Date	Insert				1/14/2013 1:40 PM
Terminations	Termination Comments	Insert				1/14/2013 1:40 PM
Terminations	Termination Date	Insert				1/14/2013 1:40 PM
Terminations	Termination Effective Date	Insert				1/14/2013 1:40 PM
Terminations	Termination Reason	Insert				1/14/2013 1:40 PM

340B Drug Pricing Program Database