Covered Entity Details

CH09067J NORTH EAST MEDICAL SERVICES (Active) - information as of 4/30/2025 10:52:41 PM

Main Details

Name

NORTH EAST MEDICAL SERVICES

Subdivision Name

NORTH EAST MEDICAL SERVICES - 1870 LUNDY

Type

HRSA-Funded Health Center

Site ID

BPS-H80-013448

340B ID

CH09067J

Grant Number

H80CS00221

Additional Details

Current Program Status

Active

Registration Date

1/8/2014

Participating Start Date

4/1/2014

Participating Approval Date

2/26/2014

Last Recertification Date

2/24/2025

Contacts

Authorizing Official

NORTH EAST MEDICAL SERVICES
EDDIE W. CHAN, PRESIDENT AND CEO
(415) 391-9686 Ext: 5905

Primary Contact

nems
BEVERLEY CHAN, PHARMACY DIRECTOR
(415) 391-9686 Ext: 5731

Addresses

Street Address

1870 Lundy Ave
San Jose, CA 95131-1826

Billing Address

NORTH EAST MEDICAL SERVICES
2171 Junipero Serra Blvd
Attn: Pharmacy Department
Suite 260
Daly City, CA 94014

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	1992747109,1013241199,1902128648,1548697444,1578211504,1013339977,1396169793,1982064549	1548697444,1992747109,1013241199,1902128648,1013339977,1396169793,1982064549,1578211504

Shipping Addresses

Shipping Address 1

North East Medical Services
1870 Lundy Ave
Attn: Pharmacy
San Jose, CA 95131-1826

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
CH090670	Active	BPS-H80-005605	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES	1520 Stockton St	San Francisco	CA
CH09067A	Active	BPS-H80-009132	NORTH EAST MEDICAL SERVICES	North East Medical Services - San Bruno Avenue	2574 San Bruno Ave	San Francisco	CA
CH09067AA	Active	BPS-H80-038686	NORTH EAST MEDICAL SERVICES	NEMS Integrative Medicine	728 Pacific Ave, Ste 303	San Francisco	CA
CH09067AB	Active	BPS-H80-038881	NORTH EAST MEDICAL SERVICES	North East Medical Services - Sullivan Suite 190	1850 Sullivan Ave, Ste 190	Daly City	CA
CH09067AC	Active	BPS-H80-039814	NORTH EAST MEDICAL SERVICES	North East Medical Services - Las Vegas	5580 W Flamingo Rd, Ste 105	Las Vegas	NV
CH09067B	Terminated	BPS-H80-009158	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - LUNDY	1715 LUNDY AVE STE 108-116	SAN JOSE	CA
CH09067C	Active	BPS-H80-008688	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - NORIEGA	1450 Noriega St	San Francisco	CA
CH09067D	Active	BPS-H80-002962	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - LELAND	82 LELAND AVE	SAN FRANCISCO	CA
CH09067E	Active	BPS-H80-005398	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - 2308 TARAVAL	2308 TARAVAL ST	SAN FRANCISCO	CA
CH09067F	Active	BPS-H80-009426	NORTH EAST MEDICAL SERVICES	North East Medical Services - Eastmoor	211 Eastmoor Ave	Daly City	CA
CH09067G	Active	BPS-H80-012129	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - CLEMENT	1019-1033 Clement Street	San Francisco	CA
CH09067H	Active	BPS-H80-012240	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - 1400 NORIEGA	1400 Noriega St	San Francisco	CA
CH09067J	Active	BPS-H80-013448	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - 1870 LUNDY	1870 Lundy Ave	San Jose	CA
CH09067K	Active	BPS-H80-019315	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - PACIFIC	728 Pacific Ave	San Francisco	CA
CH09067L	Terminated	BPS-H80-019758	NORTH EAST MEDICAL SERVICES	NORTH EAST MEDICAL SERVICES - ELLIS	518 Ellis St	San Francisco	CA
CH09067M	Active	BPS-H80-015071	North East Medical Services	NEMS SUNSET ENROLLMENT SERVICE CENTER AND RADIOLOGY	1422 Noriega St	San Francisco	CA
CH09067N	Active	BPS-H80-027743	North East Medical Services	NEMS Traditional Medicine Center - Suite 503	728 Pacific Ave	San Francisco	CA
CH09067P	Active	BPS-H80-027742	North East Medical Services	NEMS Traditional Medicine Center - Suite 403	728 Pacific Ave	San Francisco	CA
CH09067Q	Active	BPS-H80-027906	North East Medical Services	NORTH EAST MEDICAL SERVICES - TARAVAL STREET	3431 Taraval St	San Francisco	CA
CH09067R	Active	BPS-H80-030236	North East Medical Services	NORTH EAST MEDICAL SERVICES - OCEAN	1443 Ocean Ave	San Francisco	CA
CH09067S	Active	BPS-H80-030574	North East Medical Services	NORTH EAST MEDICAL SERVICES - POLK	650 Polk St	San Francisco	CA
CH09067T	Active	BPS-H80-031695	North East Medical Services	NORTH EAST MEDICAL SERVICES - 2633 SAN BRUNO	2633 San Bruno Ave	San Francisco	CA
CH09067U	Terminated	BPS-H80-034423	North East Medical Services	North East Medical Services - Pacific Pharmacy	728 Pacific Ave STE 114-115	San Francisco	CA
CH09067V	Active	BPS-H80-038196	North East Medical Services	North East Medical Services - Medical Oncology	728 Pacific Ave	San Francisco	CA
CH09067W	Active	BPS-H80-035750	North East Medical Services	North East Medical Services – 1798 19th Avenue	1798 19th Ave	San Francisco	CA
CH09067X	Active	BPS-H80-036159	North East Medical Services	North East Medical Services - Sullivan Suite 150	1850 Sullivan Avenue	Daly City	CA
CH09067Y	Active	BPS-H80-036437	North East Medical Services	NORTH EAST MEDICAL SERVICES - 1430 NORIEGA	1430 Noriega St	San Francisco	CA
CH09067Z	Active	BPS-H80-037757	North East Medical Services	NORTH EAST MEDICAL SERVICES - 1430 TARAVAL	1430 Taraval St	San Francisco	CA

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Carve-In Effective Date	Termination Date
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	2/21/2024 5:12:50 PM	2/24/2025 3:04:21 PM	2/24/2025 3:04 PM
Addresses	Billing Address	Update	Group Change Request	North East Medical Services 1520 STOCKTON STREET ATTN: PHARMACY SAN FRANCISCO, CA 94133-3354	NORTH EAST MEDICAL SERVICES 2171 Junipero Serra Blvd Attn: Pharmacy Department Suite 260 Daly City, CA 94014	2/21/2024 6:19 PM
Details	Last Recertification Date	Update	Recertification	2/21/2023 2:01:18 PM	2/21/2024 5:12:50 PM	2/21/2024 5:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	2/21/2023 2:01 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1578211504	2/21/2023 2:01 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CA	2/21/2023 2:01 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1578211504	2/21/2023 2:01 PM
Medicaid Billing	NPI: State	Insert	Recertification		CA	2/21/2023 2:01 PM
Details	Last Recertification Date	Update	Recertification	2/15/2022 12:57:54 PM	2/21/2023 2:01:18 PM	2/21/2023 2:01 PM
Details	Last Recertification Date	Update	Recertification	2/26/2021 6:10:38 PM	2/15/2022 12:57:54 PM	2/15/2022 12:57 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/26/2021 6:10 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/26/2021 6:10 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/26/2021 6:10 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/26/2021 6:10 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/26/2021 6:10 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/26/2021 6:10 PM
Medicaid Billing	NPI: State	Update	Recertification		CA	2/26/2021 6:10 PM
Details	Last Recertification Date	Update	Recertification	2/12/2020 2:29:42 PM	2/26/2021 6:10:38 PM	2/26/2021 6:10 PM
Contacts	Authorizing Official	Update	New Registration	CHAN, EDDIE W. PRESIDENT AND CEO NORTH EAST MEDICAL SERVICES 4153919686	CHAN, EDDIE W. PRESIDENT AND CEO NORTH EAST MEDICAL SERVICES 4153919686-5905	6/5/2020 7:39 PM
Contacts	Signed By	Update	New Registration	CHAN, EDDIE W. PRESIDENT AND CEO NORTH EAST MEDICAL SERVICES 4153919686	CHAN, EDDIE W. PRESIDENT AND CEO NORTH EAST MEDICAL SERVICES 4153919686-5905	6/5/2020 7:39 PM
Addresses	Shipping Address	Insert	Recertification		North East Medical Services 1870 Lundy Ave Attn: Pharmacy San Jose, CA 95131-1826	2/12/2020 2:29 PM
Details	Last Recertification Date	Update	Recertification	2/18/2019 6:59:21 PM	2/12/2020 2:29:42 PM	2/12/2020 2:29 PM
Details	Is Authorizing Official EHB Data	Update	Recertification	False		2/12/2020 2:29 PM
Details	Last Recertification Date	Update	Recertification	2/20/2018 4:46:20 PM	2/18/2019 6:59:21 PM	2/18/2019 6:59 PM
Details	Last Recertification Date	Update	Recertification	2/16/2017 12:00:00 AM	2/20/2018 4:46:20 PM	2/20/2018 4:46 PM
Contacts	Primary Contact	Update		CHAN, BEVERLEY PHARMACY DIRECTOR 4153919686-5731	CHAN, BEVERLEY PHARMACY DIRECTOR nems 4153919686-5731	12/27/2017 7:42 PM
Contacts	Authorizing Official	Update		CHAN, EDDIE W. PRESIDENT AND CEO 4153919686	CHAN, EDDIE W. PRESIDENT AND CEO NORTH EAST MEDICAL SERVICES 4153919686	11/6/2017 5:09 PM
Contacts	Signed By	Update		CHAN, EDDIE W. PRESIDENT AND CEO 4153919686	CHAN, EDDIE W. PRESIDENT AND CEO NORTH EAST MEDICAL SERVICES 4153919686	11/6/2017 5:09 PM
Contacts	Primary Contact	Insert			CHAN, BEVERLEY PHARMACY DIRECTOR 4153919686-5731	8/10/2017 5:40 PM
Contacts	Authorizing Official	Insert			CHAN, EDDIE W. PRESIDENT AND CEO 4153919686	8/10/2017 5:40 PM
Contacts	Signed By	Insert			CHAN, EDDIE W. PRESIDENT AND CEO 4153919686	8/10/2017 5:40 PM
Addresses	Main Address	Insert			1870 Lundy Ave San Jose, CA 95131-1826	8/10/2017 5:37 PM
Addresses	Billing Address	Insert			North East Medical Services 1520 STOCKTON STREET ATTN: PHARMACY SAN FRANCISCO, CA 94133-3354	8/10/2017 5:37 PM
Medicaid Billing	NPI: Number	Insert			1992747109	8/10/2017 5:36 PM
Medicaid Billing	NPI: Number	Insert			1013241199	8/10/2017 5:36 PM
Medicaid Billing	NPI: Number	Insert			1902128648	8/10/2017 5:36 PM
Medicaid Billing	NPI: Number	Insert			1013339977	8/10/2017 5:36 PM
Medicaid Billing	NPI: Number	Insert			1396169793	8/10/2017 5:36 PM
Medicaid Billing	NPI: Number	Insert			1982064549	8/10/2017 5:36 PM
Details	Last Recertification Date	Update		2/29/2016 12:00:00 AM	2/16/2017 12:00:00 AM	2/16/2017 8:09 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/29/2016 2:16 PM
Medicaid Billing	Medicaid: Number	Insert			1013339977	2/29/2016 2:16 PM
Medicaid Billing	Medicaid: State	Insert			CA	2/29/2016 2:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/29/2016 2:16 PM
Medicaid Billing	Medicaid: Number	Insert			1396169793	2/29/2016 2:16 PM
Medicaid Billing	Medicaid: State	Insert			CA	2/29/2016 2:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/29/2016 2:16 PM
Medicaid Billing	Medicaid: Number	Insert			1982064549	2/29/2016 2:16 PM
Medicaid Billing	Medicaid: State	Insert			CA	2/29/2016 2:16 PM
Details	Last Recertification Date	Update		3/4/2015 12:00:00 AM	2/29/2016 12:00:00 AM	2/29/2016 2:16 PM
Details	Last Recertification Date	Update			3/4/2015 12:00:00 AM	3/4/2015 1:28 PM
Details	Is Authorizing Official EHB Data	Update			False	3/4/2015 1:28 PM
Details	340B ID	Update		ONLINE_REG	CH09067J	2/26/2014 3:12 PM
Dates	Participating Approval Date	Update			2/26/2014 12:00:00 AM	2/26/2014 3:12 PM
Details	State	Update		Pending	Active	2/26/2014 3:12 PM
Dates	Start Date	Update			4/1/2014 12:00:00 AM	2/26/2014 3:12 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: Number	Insert			1992747109	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: State	Insert			CA	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: Number	Insert			1013241199	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: State	Insert			CA	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: Number	Insert			1902128648	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: State	Insert			CA	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: Number	Insert			1548697444	1/8/2014 3:16 PM
Medicaid Billing	Medicaid: State	Insert			CA	1/8/2014 3:16 PM
Medicaid Billing	NPI: Number	Insert			1548697444	1/8/2014 3:16 PM
Details	Last Recertification Date	Insert				1/8/2014 3:16 PM
Details	Grant Number	Insert			H80CS00221	1/8/2014 3:16 PM
Details	340B ID	Insert			ONLINE_REG	1/8/2014 3:16 PM
Details	Is Authorizing Official EHB Data	Insert				1/8/2014 3:16 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/8/2014 3:16 PM
Details	Medicare Provider Number	Insert				1/8/2014 3:16 PM
Details	Entity Name	Insert			NORTH EAST MEDICAL SERVICES	1/8/2014 3:16 PM
Details	Program Code	Insert			CH	1/8/2014 3:16 PM
Details	Entity Subname	Insert			NORTH EAST MEDICAL SERVICES - 1870 LUNDY	1/8/2014 3:16 PM
Dates	Participating Approval Date	Insert				1/8/2014 3:16 PM
Details	State	Insert			Pending	1/8/2014 3:16 PM
Dates	Registration Date	Insert			1/8/2014 12:00:00 AM	1/8/2014 3:16 PM
Dates	Signed By Date	Insert			1/8/2014 12:00:00 AM	1/8/2014 3:16 PM
Dates	Start Date	Insert				1/8/2014 3:16 PM
Terminations	Termination Comments	Insert				1/8/2014 3:16 PM
Terminations	Termination Date	Insert				1/8/2014 3:16 PM
Terminations	Termination Effective Date	Insert				1/8/2014 3:16 PM
Terminations	Termination Reason	Insert				1/8/2014 3:16 PM

340B Drug Pricing Program Database