340B Drug Pricing Program Database


DSH050038D SANTA CLARA VALLEY MEDICAL CENTER (Active) - information as of 4/25/2025 5:41:15 PM

Main Details
SANTA CLARA VALLEY MEDICAL CENTER
SANTA CLARA VALLEY MEDICAL CENTER - PACE CLINIC
Disproportionate Share Hospital
No
DSH050038D
050038


Additional Details
Active
5/30/2018
7/1/2018
6/1/2018
8/14/2024

Contacts

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

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

Addresses

2400 MOORPARK AVE STE 316
SAN JOSE, CA 95128-2604

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CA1487286951,PHB357910,PHA338350,1285081596,PHB403980,PHB195650,1275992406,1821241035,PHA404740,PHB323270,PHB169510,PHA414160,PHB3009001720136765,1518045715,1285081596,1891871919,1164507018,1275992406,1821241035,1255417374,1104904390,1619053733,1528144649,1790863991,1063406551,1487286951,1770238677,1598418196,1679261473,1538864608,1326873795
Shipping Addresses

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

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

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

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

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

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

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

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

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

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

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

SCVMC Oncology Infusion Pharmacy
751 South Bascom Ave
Room BQ115
San Jose, CA 95128

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

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

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

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

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

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

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

Valley Health Center at North County Pharmacy
4151 Middlefield Rd #300
Palo Alto, CA 94303
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH050038AAChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Nuclear Medicine2105 Forest AveSan JoseCAActive
DSH050038ABChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Medical Intensive Care - Observation2105 Forest AveSan JoseCATerminated
DSH050038ACChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - EEG/EMG2105 Forest AveSan JoseCAActive
DSH050038ADChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Oncology Acute - Observation2105 Forest AveSan JoseCATerminated
DSH050038AEChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Renal Hemo Center2105 Forest AveSan JoseCAActive
DSH050038AFChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Physical Therapy - Acute2105 Forest AveSan JoseCAActive
DSH050038AGChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - ER - Treatment2105 Forest AveSan JoseCAActive
DSH050038AHChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Anesthesiology2105 Forest AveSan JoseCAActive
DSH050038AJChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Labor and Delivery2105 Forest AveSan JoseCAActive
DSH050038AKChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Infusion Center2105 Forest AveSan JoseCAActive
DSH050038ALChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Hyperbaric Oxygen Clinic2105 Forest AveSan JoseCATerminated
DSH050038AMChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Observation/Short Stay2105 Forest AveSan JoseCATerminated
DSH050038ANChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Pulmonary/Resp Med2105 Forest AveSan JoseCATerminated
DSH050038APChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Radiology - Angio/Special2105 Forest AveSan JoseCAActive
DSH050038AQChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Radiology - Ultra Sound2105 Forest AveSan JoseCAActive
DSH050038ARChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Radiology - CT Scanner2105 Forest AveSan JoseCAActive
DSH050038ASChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Med/Surge Ortho Observation2105 Forest AveSan JoseCATerminated
DSH050038ATChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - OR Surgery Services2105 Forest AveSan JoseCAActive
DSH050038AUChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Radiology - MRI2105 Forest AveSan JoseCAActive
DSH050038AVChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Cardiology Svc-Cardiac Rehab2105 Forest AveSan JoseCAActive
DSH050038AWChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Other Med/Surge Acute - Observation2105 Forest AveSan JoseCATerminated
DSH050038AXChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - OR Recovery/PACU2105 Forest AveSan JoseCAActive
DSH050038AYChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Endoscopy Procedures2105 Forest AveSan JoseCAActive
DSH050038AZChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Radiation Therapy2105 Forest AveSan JoseCATerminated
DSH050038BChildDSHSANTA CLARA VALLEY MEDICAL CENTERSCC EMERGENCY PSYCHIATRIC SERVICES871 ENBORG CTSAN JOSECAActive
DSH050038BAChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Cardiac Cath - Lab2105 Forest AveSan JoseCAActive
DSH050038BBChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - EKG2105 Forest AveSan JoseCAActive
DSH050038BCChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - ASU-Ambul Surgical Care2105 Forest AveSan JoseCATerminated
DSH050038BDChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Pediatric - Acute / Rehab - Observation2105 Forest AveSan JoseCATerminated
DSH050038BEChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Respiratory Care2105 Forest AveSan JoseCAActive
DSH050038BFChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Radiology Diagnostic2105 Forest AveSan JoseCAActive
DSH050038BGChildDSHSANTA CLARA VALLEY MEDICAL CENTEROCH - Rehab/Wound Care125 CIRO AVE, # 201San JoseCAActive
DSH050038BHChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Occupational Therapy9400 No Name UnoGilroyCAActive
DSH050038BJChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Physical Therapy9400 No Name UnoGilroyCAActive
DSH050038BKChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - OR Recovery/PACU9400 No Name UnoGilroyCAActive
DSH050038BLChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - ECHOCARDIOLOGY9400 NO NAME UNOGILROYCAActive
DSH050038BMChildDSHSANTA CLARA VALLEY MEDICAL CENTERCHILD ADVOCACY CENTER CLINIC (PEDIATRIC CLINIC)455 O'Connor Dr., Suite #150San JoseCAActive
DSH050038CChildDSHSANTA CLARA VALLEY MEDICAL CENTERSCVMC RENAL CARE CENTER2220 MOORPARK AVESAN JOSECAActive
DSH050038DChildDSHSANTA CLARA VALLEY MEDICAL CENTERSANTA CLARA VALLEY MEDICAL CENTER - PACE CLINIC2400 MOORPARK AVE STE 316SAN JOSECAActive
DSH050038EChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - OR Surgery Services9400 No Name UnoGilroyCAActive
DSH050038FChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Anesthesiology9400 No Name UnoGilroyCAActive
DSH050038GChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Observation/Short Stay9400 No Name UnoGilroyCATerminated
DSH050038HChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Radiology - MRI9400 No Name UnoGilroyCAActive
DSH050038JChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - ER - Treatment9400 No Name UnoGilroyCAActive
DSH050038KChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Renal Hemo Center9400 No Name UnoGilroyCATerminated
DSH050038LChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Radiology - Ultra Sound9400 No Name UnoGilroyCAActive
DSH050038MChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Respiratory Care9400 No Name UnoGilroyCAActive
DSH050038NChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Nuclear Medicine9400 No Name UnoGilroyCAActive
DSH050038PChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Newborn Nursery - Observation9400 No Name UnoGilroyCATerminated
DSH050038QChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Obstetrics / Maternity - Observation9400 No Name UnoGilroyCATerminated
DSH050038RChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Infusion Center9400 No Name UnoGilroyCAActive
DSH050038SChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Acute Speech9400 No Name UnoGilroyCAActive
DSH050038TChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Radiology Diagnostic9400 No Name UnoGilroyCAActive
DSH050038UChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Other Med/Surge Acute - Observation9400 No Name UnoGilroyCATerminated
DSH050038VChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Rehab/Wound Care9400 No Name UnoGilroyCAActive
DSH050038WChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Labor and Delivery9400 No Name UnoGilroyCAActive
DSH050038XChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Hyperbaric Oxygen Clinic9400 No Name UnoGilroyCATerminated
DSH050038YChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Radiology - CT Scanner9400 No Name UnoGilroyCAActive
DSH050038ZChildDSHSANTA CLARA VALLEY MEDICAL CENTERSLR - Medical Intensive Care - Observation9400 No Name UnoGilroyCATerminated
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertGroup Change Request Valley Health Center at North County Pharmacy 4151 Middlefield Rd #300 Palo Alto, CA 9430310/7/2024 6:54 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 132687379510/7/2024 6:54 AM
Medicaid BillingNPI: StateInsertGroup Change Request CA10/7/2024 6:54 AM
DetailsLast Recertification DateUpdateRecertification9/7/2023 3:00:58 PM8/14/2024 7:31:59 PM8/14/2024 7:31 PM
AddressesShipping AddressInsertGroup Change Request Valley Health Center at Morgan Hill Pharmacy 18550 De Paul Drive Suite 150 Morgan Hill, CA 950371/30/2024 6:42 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 15388646081/30/2024 6:42 AM
Medicaid BillingNPI: StateInsertGroup Change Request CA1/30/2024 6:42 AM
AddressesShipping AddressDeleteGroup Change RequestVHC at Bascom Pharmacy 750 South Bascom Ave San Jose, CA 95128 9/22/2023 7:09 AM
AddressesShipping AddressInsertGroup Change Request Valley Health Center at Lundy Pharmacy 1996 Lundy Ave Ste B San Jose, CA 951319/22/2023 7:09 AM
AddressesShipping AddressInsertGroup Change Request Valley Health Center at San Jose Pharmacy 750 South Bascom Ave San Jose, CA 951289/22/2023 7:09 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16792614739/22/2023 7:09 AM
Medicaid BillingNPI: StateInsertGroup Change Request CA9/22/2023 7:09 AM
DetailsLast Recertification DateUpdateRecertification9/14/2022 7:57:36 PM9/7/2023 3:00:58 PM9/7/2023 3:00 PM
AddressesShipping AddressDeleteGroup Change RequestValley Health Center at Sunnyvale Pharma 660 South Fair Oaks Avenue Suite 1057 Sunnyvale, CA 94086 8/10/2023 11:11 AM
AddressesShipping AddressDeleteGroup Change RequestSanta Clara Valley Medical Center Disch Pharmacy 751 South Bascom Ave, Main Hospital Buil San Jose, CA 95128-2406 8/10/2023 11:11 AM
AddressesShipping AddressInsertGroup Change Request Valley Health Center at Sunnyvale Pharmacy 660 South Fair Oaks Avenue Suite 1057 Sunnyvale, CA 940868/10/2023 11:11 AM
AddressesShipping AddressInsertGroup Change Request Santa Clara Valley Medical Center Discharge Pharmacy 751 South Bascom Ave, Main Hospital Building San Jose, CA 95128-24068/10/2023 11:11 AM
DetailsLast Recertification DateUpdateRecertification9/13/2021 8:07:51 AM9/14/2022 7:57:36 PM9/14/2022 7:57 PM
AddressesShipping AddressDeleteGroup Change RequestSanta Clara Valley Health Care Multi-Specialty 2500 California St Suite D Mountain View, CA 94040 3/2/2022 7:07 AM
AddressesShipping AddressDeleteGroup Change RequestValley Health Center at VASC Pharmacy 2410 Senter Road Room 209 San Jose, CA 95111 3/2/2022 7:07 AM
AddressesShipping AddressInsertGroup Change Request Santa Clara Valley Health Care Multi-Specialty Clinic Pharmacy 2500 California St Ste D Mountain View, CA 940403/2/2022 7:07 AM
AddressesShipping AddressInsertGroup Change Request Valley Health Center at VASC Pharmacy 2410 Senter Rd Rm 209 San Jose, CA 951113/2/2022 7:07 AM
AddressesShipping AddressInsertGroup Change Request Valley Health Center at VASC Pharmacy 2410 Senter Road Room 209 San Jose, CA 951112/22/2022 7:17 AM
AddressesShipping AddressInsertGroup Change Request Santa Clara Valley Health Care Multi-Specialty 2500 California St Suite D Mountain View, CA 940402/22/2022 7:17 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 17702386772/22/2022 7:17 AM
Medicaid BillingNPI: StateInsertGroup Change Request CA2/22/2022 7:17 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 15984181962/22/2022 7:17 AM
Medicaid BillingNPI: StateInsertGroup Change Request CA2/22/2022 7:17 AM
AddressesShipping AddressDeleteRecertificationVHC @ Milpitas Pharmacy 143 N Main St Suite 1038 Milpitas, CA 95035 9/13/2021 8:07 AM
AddressesShipping AddressDeleteRecertificationO'Connor Out-Patient Pharmacy 2101 Forest Ave Ste 122 San Jose, CA 95128-1424 9/13/2021 8:07 AM
AddressesShipping AddressDeleteRecertificationSanta Clara Valley Medical Center Discharge Pharmacy 751 S Bascom Ave Main Hospital Building San Jose, CA 95128 9/13/2021 8:07 AM
AddressesShipping AddressDeleteRecertificationValley Health Center @ Gilroy Pharmacy 7475 Camino Arroyo Suite 1025 Gilroy, CA 95020 9/13/2021 8:07 AM
AddressesShipping AddressDeleteRecertificationValley Health Center at Downtown Pharmacy 777 E. Santa Clara St San Jose, CA 95112 9/13/2021 8:07 AM
AddressesShipping AddressDeleteRecertificationSanta Clara Valley Medical Center Outpatient Pharmacy 751 South Bascom Ave. Suite 150 San Jose, CA 95128 9/13/2021 8:07 AM
AddressesShipping AddressDeleteRecertificationSCVH&HS Refill Center Pharmacy 871 Enborg Court Unit 200 San Jose, CA 95128 9/13/2021 8:07 AM
AddressesShipping AddressDeleteRecertificationEnborg Lane Pharmacy 2221 Enborg Lane Ste 1J018 San Jose, CA 95128 9/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification Santa Clara Valley Medical Center Outpatient Pharmacy 751 S Bascom Ave. Ste 150 San Jose, CA 95128-26049/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification SCVH&HS Refill Ctr Pharmacy 871 Enborg Court Unit 200 San Jose, CA 951289/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification Enborg Lane Pharmacy 2221 Enborg Lane 1J018 San Jose, CA 951289/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification Santa Clara Valley Medical Center Disch Pharmacy 751 South Bascom Ave, Main Hospital Buil San Jose, CA 95128-24069/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification Valley Health Center @ Gilroy Pharmacy 7475 Camino Arroyo Suite 1025 Gilroy, CA 95020-73409/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification Valley Health Center at Downtown Pharmacy 777 E. Santa Clara St San Jose, CA 95112-19099/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification VHC @ Milpitas Pharmacy 143 N Main St Suite 1038 Milpitas, CA 95035-43229/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification O'Connor Out-Patient Pharmacy 2101 Forest Ave Suite 122 San Jose, CA 95128-14249/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification SCVMC Oncology Infusion Pharmacy 751 South Bascom Ave Room BQ115 San Jose, CA 951289/13/2021 8:07 AM
DetailsLast Recertification DateUpdateRecertification9/11/2020 7:41:07 AM9/13/2021 8:07:51 AM9/13/2021 8:07 AM
AddressesShipping AddressInsertRecertification O'Connor Out-Patient Pharmacy 2101 Forest Ave Ste 122 San Jose, CA 95128-14249/11/2020 7:41 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 7:41 AM
Medicaid BillingMedicaid: NumberInsertRecertification 14872869519/11/2020 7:41 AM
Medicaid BillingMedicaid: StateInsertRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: NumberInsertRecertification 14872869519/11/2020 7:41 AM
Medicaid BillingNPI: StateInsertRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
Medicaid BillingNPI: StateUpdateRecertification CA9/11/2020 7:41 AM
DetailsLast Recertification DateUpdateRecertification8/29/2019 7:18:21 AM9/11/2020 7:41:07 AM9/11/2020 7:41 AM
AddressesShipping AddressDeleteRecertificationSanta Clara County Public VHC Lenzen Pharmacy 976 Lenzen Avenue San Jose, CA 95126 8/29/2019 7:18 AM
AddressesShipping AddressDeleteRecertificationSanta Clara Valley Medical Center Discharge Pharmacy 751 S Bascom Ave, Main Hospital Building San Jose, CA 95128 8/29/2019 7:18 AM
AddressesShipping AddressDeleteRecertificationValley Health Center @ Gilroy Pharmacy 7475 Camino Arroyo, Suite 1025 Gilroy, CA 95020 8/29/2019 7:18 AM
AddressesShipping AddressDeleteRecertificationValley Health Center at Downtown Pharmacy 777 E. Santa Clara St. San Jose, CA 95112 8/29/2019 7:18 AM
AddressesShipping AddressDeleteRecertificationVHC @ Milpitas Pharmacy 143 N Main Street Suite 1038 Milpitas, CA 95035 8/29/2019 7:18 AM
AddressesShipping AddressDeleteRecertificationVHC at East Valley Pharmacy 1993 McKee Road San Jose, CA 95116 8/29/2019 7:18 AM
AddressesShipping AddressInsertRecertification Santa Clara County Public VHC at Lenzen Pharmacy 976 Lenzen Avenue San Jose, CA 951268/29/2019 7:18 AM
AddressesShipping AddressInsertRecertification Santa Clara Valley Medical Center Discharge Pharmacy 751 S Bascom Ave Main Hospital Building San Jose, CA 951288/29/2019 7:18 AM
AddressesShipping AddressInsertRecertification Valley Health Center @ Gilroy Pharmacy 7475 Camino Arroyo Suite 1025 Gilroy, CA 950208/29/2019 7:18 AM
AddressesShipping AddressInsertRecertification Valley Health Center at Downtown Pharmacy 777 E. Santa Clara St San Jose, CA 951128/29/2019 7:18 AM
AddressesShipping AddressInsertRecertification VHC @ Milpitas Pharmacy 143 N Main St Suite 1038 Milpitas, CA 950358/29/2019 7:18 AM
AddressesShipping AddressInsertRecertification VHC at East Valley Pharmacy 1993 McKee Rd San Jose, CA 951168/29/2019 7:18 AM
DetailsLast Recertification DateUpdateRecertification8/29/2018 4:47:56 PM8/29/2019 7:18:21 AM8/29/2019 7:18 AM
DetailsLast Recertification DateUpdateRecertification 8/29/2018 4:47:56 PM8/29/2018 4:47 PM
DetailsStateUpdate ApprovedActive7/1/2018 12:00 AM
ContactsSigned ByInsertNew Registration Singh, Narinder Director of Pharmacy SCVMC 40888523006/1/2018 8:59 AM
Details340B IDUpdateNew Registration DSH050038D6/1/2018 8:59 AM
DetailsEntity SubnameUpdateNew RegistrationSANTA CLARA VALLEY MEDICAL CENTERSANTA CLARA VALLEY MEDICAL CENTER - PACE CLINIC6/1/2018 8:59 AM
DatesParticipating Approval DateUpdateNew Registration 6/1/2018 8:59:23 AM6/1/2018 8:59 AM
DetailsStateUpdateNew RegistrationPendingApproved6/1/2018 8:59 AM
DatesSigned By DateUpdateNew Registration 5/30/2018 3:34:49 PM6/1/2018 8:59 AM
DatesStart DateUpdateNew Registration 7/1/2018 12:00:00 AM6/1/2018 8:59 AM
AddressesMain AddressInsertNew Registration  2400 MOORPARK AVE STE 316 SAN JOSE, CA 95128-26045/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration Santa Clara County Public VHC Lenzen Pharmacy 976 Lenzen Avenue San Jose, CA 951265/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration Santa Clara Valley Medical Center Discharge Pharmacy 751 S Bascom Ave, Main Hospital Building San Jose, CA 951285/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration Santa Clara Valley Medical Center Outpatient Pharmacy 751 South Bascom Ave. Suite 150 San Jose, CA 951285/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration SCVH&HS Refill Center Pharmacy 871 Enborg Court Unit 200 San Jose, CA 951285/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration Valley Health Center @ Gilroy Pharmacy 7475 Camino Arroyo, Suite 1025 Gilroy, CA 950205/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration Valley Health Center at Downtown Pharmacy 777 E. Santa Clara St. San Jose, CA 951125/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration Valley Health Center at Sunnyvale Pharma 660 South Fair Oaks Avenue Suite 1057 Sunnyvale, CA 940865/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration VHC @ Milpitas Pharmacy 143 N Main Street Suite 1038 Milpitas, CA 950355/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration VHC at Bascom Pharmacy 750 South Bascom Ave San Jose, CA 951285/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration VHC at East Valley Pharmacy 1993 McKee Road San Jose, CA 951165/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration VHC at Moorpark Pharmacy 2400 Moorpark Avenue Suite 101 San Jose, CA 951285/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration VHC at Tully Pharmacy 500 Tully Road San Jose, CA 951115/30/2018 3:34 PM
AddressesShipping AddressInsertNew Registration Enborg Lane Pharmacy 2221 Enborg Lane Ste 1J018 San Jose, CA 951285/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHB3579105/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHA3383505/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 12850815965/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHB4039805/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHB1956505/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 12759924065/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 18212410355/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHA4047405/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHB3232705/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHB1695105/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHA4141605/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False5/30/2018 3:34 PM
Medicaid BillingMedicaid: NumberInsertNew Registration PHB3009005/30/2018 3:34 PM
Medicaid BillingMedicaid: StateInsertNew Registration CA5/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 17201367655/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 15180457155/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 12850815965/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 18918719195/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 11645070185/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 12759924065/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 18212410355/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 12554173745/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 11049043905/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 16190537335/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 15281446495/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 17908639915/30/2018 3:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 10634065515/30/2018 3:34 PM
ContactsPrimary ContactInsertNew Registration Yoon, Jennefer Assistant Director of Pharmacy Santa Clara Valley Health and Hospital System 40888576365/30/2018 3:34 PM
ContactsAuthorizing OfficialInsertNew Registration Singh, Narinder Director of Pharmacy SCVMC 40888523005/30/2018 3:34 PM
DetailsLast Recertification DateInsertNew Registration  5/30/2018 3:34 PM
DetailsGrant NumberInsertNew Registration  5/30/2018 3:34 PM
Details340B IDInsertNew Registration  5/30/2018 3:34 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  5/30/2018 3:34 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  5/30/2018 3:34 PM
DetailsMedicare Provider NumberInsertNew Registration 0500385/30/2018 3:34 PM
DetailsEntity NameInsertNew Registration SANTA CLARA VALLEY MEDICAL CENTER5/30/2018 3:34 PM
DetailsProgram CodeInsertNew Registration DSH5/30/2018 3:34 PM
DetailsEntity SubnameInsertNew Registration SANTA CLARA VALLEY MEDICAL CENTER5/30/2018 3:34 PM
DatesParticipating Approval DateInsertNew Registration  5/30/2018 3:34 PM
DetailsStateInsertNew Registration Pending5/30/2018 3:34 PM
DatesRegistration DateInsertNew Registration 5/30/2018 3:34:45 PM5/30/2018 3:34 PM
DatesSigned By DateInsertNew Registration  5/30/2018 3:34 PM
DatesStart DateInsertNew Registration  5/30/2018 3:34 PM
TerminationsTermination CommentsInsertNew Registration  5/30/2018 3:34 PM
TerminationsTermination DateInsertNew Registration  5/30/2018 3:34 PM
TerminationsTermination Effective DateInsertNew Registration  5/30/2018 3:34 PM
TerminationsTermination ReasonInsertNew Registration  5/30/2018 3:34 PM