| Details | Last Recertification Date | Update | Recertification | 2/21/2024 3:14:10 PM | 2/20/2025 5:14:09 PM | 2/20/2025 5:14 PM |
| Addresses | Shipping Address | Insert | Group Change Request | | Valley Health Center at North County Pharmacy
4151 Middlefield Rd #300
Palo Alto, CA 94303 | 10/7/2024 9:53 AM |
| Medicaid Billing | NPI: Number | Insert | Group Change Request | | 1326873795 | 10/7/2024 9:53 AM |
| Medicaid Billing | NPI: State | Insert | Group Change Request | | CA | 10/7/2024 9:53 AM |
| Details | Last Recertification Date | Update | Recertification | 2/22/2023 8:12:03 AM | 2/21/2024 3:14:10 PM | 2/21/2024 3:14 PM |
| Addresses | Shipping Address | Insert | Group Change Request | | Valley Health Center at Morgan Hill Pharmacy
18550 De Paul Drive Suite 150
Morgan Hill, CA 95037 | 1/26/2024 12:52 PM |
| Medicaid Billing | NPI: Number | Insert | Group Change Request | | 1538864608 | 1/26/2024 12:52 PM |
| Medicaid Billing | NPI: State | Insert | Group Change Request | | CA | 1/26/2024 12:52 PM |
| Addresses | Shipping Address | Delete | Group Change Request | VHC at Bascom Pharmacy
750 South Bascom Ave
San Jose, CA 95128 | | 9/25/2023 9:36 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | Valley Health Center at Lundy Pharmacy
1996 Lundy Ave Ste B
San Jose, CA 95131 | 9/25/2023 9:36 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | Valley Health Center at San Jose Pharmacy
750 South Bascom Ave
San Jose, CA 95128 | 9/25/2023 9:36 AM |
| Medicaid Billing | NPI: Number | Insert | Group Change Request | | 1679261473 | 9/25/2023 9:36 AM |
| Medicaid Billing | NPI: State | Insert | Group Change Request | | CA | 9/25/2023 9:36 AM |
| Addresses | Shipping Address | Delete | Recertification | Valley Health Center at Sunnyvale Pharma
660 South Fair Oaks Avenue Suite 1057
Sunnyvale, CA 94086 | | 2/22/2023 8:12 AM |
| Addresses | Shipping Address | Delete | Recertification | Santa Clara Valley Medical Center Disch Pharmacy
751 South Bascom Ave, Main Hospital Buil
San Jose, CA 95128-2406 | | 2/22/2023 8:12 AM |
| Addresses | Shipping Address | Insert | Recertification | | Valley Health Center at Sunnyvale Pharmacy
660 South Fair Oaks Avenue Suite 1057
Sunnyvale, CA 94086 | 2/22/2023 8:12 AM |
| Addresses | Shipping Address | Insert | Recertification | | Santa Clara Valley Medical Center Discharge Pharmacy
751 South Bascom Ave, Main Hospital Building
San Jose, CA 95128-2406 | 2/22/2023 8:12 AM |
| Details | Last Recertification Date | Update | Recertification | 2/25/2022 9:40:53 AM | 2/22/2023 8:12:03 AM | 2/22/2023 8:12 AM |
| Addresses | Shipping Address | Delete | Group Change Request | Valley Health Center at VASC Pharmacy
2410 Senter Road Room 209
San Jose, CA 95111 | | 3/3/2022 6:31 AM |
| Addresses | Shipping Address | Delete | Group Change Request | Santa Clara Valley Health Care Multi-Specialty
2500 California St Suite D
Mountain View, CA 94040 | | 3/3/2022 6:31 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | Santa Clara Valley Health Care Multi-Specialty Clinic Pharmacy
2500 California St Ste D
Mountain View, CA 94040 | 3/3/2022 6:31 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | Valley Health Center at VASC Pharmacy
2410 Senter Rd Rm 209
San Jose, CA 95111 | 3/3/2022 6:31 AM |
| Addresses | Shipping Address | Delete | Recertification | O'Connor Out-Patient Pharmacy
2101 Forest Ave Ste 122
San Jose, CA 95128-1424 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Delete | Recertification | Santa Clara County Public VHC Lenzen Pharmacy
976 Lenzen Avenue
San Jose, CA 95126 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Delete | Recertification | VHC @ Milpitas Pharmacy
143 N Main Street Suite 1038
Milpitas, CA 95035 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Delete | Recertification | SCVH&HS Refill Center Pharmacy
871 Enborg Court Unit 200
San Jose, CA 95128 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Delete | Recertification | VHC at East Valley Pharmacy
1993 McKee Road
San Jose, CA 95116 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Delete | Recertification | Valley Health Center @ Gilroy Pharmacy
7475 Camino Arroyo, Suite 1025
Gilroy, CA 95020 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Delete | Recertification | Enborg Lane Pharmacy
2221 Enborg Lane Ste 1J018
San Jose, CA 95128 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Delete | Recertification | Santa Clara Valley Medical Center Outpatient Pharmacy
751 South Bascom Ave. Suite 150
San Jose, CA 95128 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Delete | Recertification | Valley Health Center at Downtown Pharmacy
777 E. Santa Clara St.
San Jose, CA 95112 | | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | Enborg Lane Pharmacy
2221 Enborg Lane
1J018
San Jose, CA 95128 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | Santa Clara Valley Medical Center Outpatient Pharmacy
751 S Bascom Ave. Ste 150
San Jose, CA 95128-2604 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | Valley Health Center at Downtown Pharmacy
777 E. Santa Clara St
San Jose, CA 95112-1909 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | VHC at East Valley Pharmacy
1993 McKee Rd
San Jose, CA 95116 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | Valley Health Center @ Gilroy Pharmacy
7475 Camino Arroyo Suite 1025
Gilroy, CA 95020-7340 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | Santa Clara County Public VHC at Lenzen Pharmacy
976 Lenzen Avenue
San Jose, CA 95126 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | VHC @ Milpitas Pharmacy
143 N Main St Suite 1038
Milpitas, CA 95035-4322 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | SCVH&HS Refill Ctr Pharmacy
871 Enborg Court Unit 200
San Jose, CA 95128 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | O'Connor Out-Patient Pharmacy
2101 Forest Ave Suite 122
San Jose, CA 95128-1424 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | Valley Health Center at VASC Pharmacy
2410 Senter Road Room 209
San Jose, CA 95111 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | Santa Clara Valley Health Care Multi-Specialty
2500 California St Suite D
Mountain View, CA 94040 | 2/25/2022 9:40 AM |
| Addresses | Shipping Address | Insert | Recertification | | Santa Clara Valley Medical Center Disch Pharmacy
751 South Bascom Ave, Main Hospital Buil
San Jose, CA 95128-2406 | 2/25/2022 9:40 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1770238677 | 2/25/2022 9:40 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | CA | 2/25/2022 9:40 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1598418196 | 2/25/2022 9:40 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | CA | 2/25/2022 9:40 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1285081596 | 2/25/2022 9:40 AM |
| Medicaid Billing | NPI: State | Insert | Recertification | | CA | 2/25/2022 9:40 AM |
| Details | Last Recertification Date | Update | Recertification | 2/22/2021 1:23:43 PM | 2/25/2022 9:40:53 AM | 2/25/2022 9:40 AM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Medicaid Billing | NPI: State | Update | Recertification | | CA | 2/22/2021 1:23 PM |
| Details | Last Recertification Date | Update | Recertification | 2/19/2020 7:33:15 AM | 2/22/2021 1:23:43 PM | 2/22/2021 1:23 PM |
| Addresses | Main Address | Update | Recertification |
2400 Moorpark Ave Ste 105
San Jose, CA 95128-2631 |
2400 Moorpark Ave Ste 105
San Jose, CA 95128-2623 | 2/19/2020 7:33 AM |
| Addresses | Shipping Address | Insert | Recertification | | O'Connor Out-Patient Pharmacy
2101 Forest Ave Ste 122
San Jose, CA 95128-1424 | 2/19/2020 7:33 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 2/19/2020 7:33 AM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 1487286951 | 2/19/2020 7:33 AM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | CA | 2/19/2020 7:33 AM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1487286951 | 2/19/2020 7:33 AM |
| Details | Last Recertification Date | Update | Recertification | 2/20/2019 5:51:07 PM | 2/19/2020 7:33:15 AM | 2/19/2020 7:33 AM |
| Details | Last Recertification Date | Update | Recertification | | 2/20/2019 5:51:07 PM | 2/20/2019 5:51 PM |
| Contacts | Primary Contact | Update | Change Request | Singh, Narinder
Director of Pharmacy
SCVMC
4088852300 | Yoon, Jennefer
Assistant Director of Pharmacy
Santa Clara Valley Health and Hospital System
4088857636 | 5/15/2018 7:55 AM |
| Contacts | Authorizing Official | Update | Change Request | Lorenz, Paul Edward
Chief Executive Officer
SCVMC
4088854004 | Singh, Narinder
Director of Pharmacy
SCVMC
4088852300 | 5/15/2018 7:55 AM |
| Details | State | Update | Change Request | Approved | Active | 5/15/2018 7:55 AM |
| Contacts | Signed By | Insert | New Registration | | Lorenz, Paul Edward
Chief Executive Officer
SCVMC
4088854004 | 4/13/2018 9:10 AM |
| Details | 340B ID | Update | New Registration | | CH091181Y | 4/13/2018 9:10 AM |
| Dates | Participating Approval Date | Update | New Registration | | 4/13/2018 9:10:07 AM | 4/13/2018 9:10 AM |
| Details | State | Update | New Registration | Pending | Approved | 4/13/2018 9:10 AM |
| Dates | Signed By Date | Update | New Registration | | 4/12/2018 3:18:58 PM | 4/13/2018 9:10 AM |
| Dates | Start Date | Update | New Registration | | 7/1/2018 12:00:00 AM | 4/13/2018 9:10 AM |
| Addresses | Main Address | Insert | New Registration | |
2400 Moorpark Ave Ste 105
San Jose, CA 95128-2631 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | Enborg Lane Pharmacy
2221 Enborg Lane Ste 1J018
San Jose, CA 95128 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | Santa Clara Valley Medical Center Outpatient Pharmacy
751 South Bascom Ave. Suite 150
San Jose, CA 95128 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC at Bascom Pharmacy
750 South Bascom Ave
San Jose, CA 95128 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center at Downtown Pharmacy
777 E. Santa Clara St.
San Jose, CA 95112 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC at East Valley Pharmacy
1993 McKee Road
San Jose, CA 95116 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center @ Gilroy Pharmacy
7475 Camino Arroyo, Suite 1025
Gilroy, CA 95020 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | Santa Clara County Public VHC Lenzen Pharmacy
976 Lenzen Avenue
San Jose, CA 95126 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC @ Milpitas Pharmacy
143 N Main Street Suite 1038
Milpitas, CA 95035 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC at Moorpark Pharmacy
2400 Moorpark Avenue Suite 101
San Jose, CA 95128 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | Valley Health Center at Sunnyvale Pharma
660 South Fair Oaks Avenue Suite 1057
Sunnyvale, CA 94086 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | VHC at Tully Pharmacy
500 Tully Road
San Jose, CA 95111 | 4/11/2018 6:13 PM |
| Addresses | Shipping Address | Insert | New Registration | | SCVH&HS Refill Center Pharmacy
871 Enborg Court Unit 200
San Jose, CA 95128 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | FHC70534F | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHB357910 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHB403980 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHB323270 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 1275992406 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHB169510 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHB195650 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHA338350 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHA404740 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHA414160 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | 1821241035 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | New Registration | | False | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: Number | Insert | New Registration | | PHB300900 | 4/11/2018 6:13 PM |
| Medicaid Billing | Medicaid: State | Insert | New Registration | | CA | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1336135912 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1720136765 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1891871919 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1104904390 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1275992406 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1619053733 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1164507018 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1518045715 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1255417374 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1528144649 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1821241035 | 4/11/2018 6:13 PM |
| Medicaid Billing | NPI: Number | Insert | New Registration | | 1790863991 | 4/11/2018 6:13 PM |
| Contacts | Primary Contact | Insert | New Registration | | Singh, Narinder
Director of Pharmacy
SCVMC
4088852300 | 4/11/2018 6:13 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Lorenz, Paul Edward
Chief Executive Officer
SCVMC
4088854004 | 4/11/2018 6:13 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Details | Grant Number | Insert | New Registration | | H80CS01442 | 4/11/2018 6:13 PM |
| Details | 340B ID | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Details | Entity Name | Insert | New Registration | | SANTA CLARA, COUNTY OF | 4/11/2018 6:13 PM |
| Details | Program Code | Insert | New Registration | | CH | 4/11/2018 6:13 PM |
| Details | Entity Subname | Insert | New Registration | | VHC Moorpark - Lab | 4/11/2018 6:13 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Details | State | Insert | New Registration | | Pending | 4/11/2018 6:13 PM |
| Dates | Registration Date | Insert | New Registration | | 4/11/2018 6:13:21 PM | 4/11/2018 6:13 PM |
| Dates | Signed By Date | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Dates | Start Date | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Terminations | Termination Date | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/11/2018 6:13 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/11/2018 6:13 PM |