Contract Pharmacy Details

SANTA CLARA COUNTY PUBLIC
RWI95128 IRA GREENE PACE CLINIC

Covered Entity Details

Entity Name

IRA GREENE PACE CLINIC

Subdivision Name

Type

Ryan White Part A

340B ID

RWI95128

Entity Address

2400 MOORPARK
SUITE 316
SAN JOSE, CA 95128

Grant Number

SAN JOSE EMA

Participating Start Date

4/1/2006

Last Recertification Date

3/6/2018

Entity Termination Date

4/1/2019

Pharmacy Details

Pharmacy Name

SANTA CLARA COUNTY PUBLIC

Pharmacy Address

VHC AT LENZEN PHARMACY
976 LENZEN AVENUE
SAN JOSE, CA 95126

Pharmacy Comments

Contract Details

Approval Date

4/21/2006

Contract Begin Date

4/21/2006

Carve-In Effective Date

Contract Comments

4/21/06 – PREVIOUSLY INCORRECTLY LISTED AS SHIPPING ADDRESS FOR RWI95128

Contract Termination Date
Termination Reason

5/2/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

4/12/2006

340B Drug Pricing Program Database