Contract Pharmacy Details

ENBORG LANE PHARMACY
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

ENBORG LANE PHARMACY

Pharmacy Address

2221 ENBORG LANE
1J018
SAN JOSE, CA 95128

Pharmacy Comments

Contract Details

Approval Date

2/11/2013

Contract Begin Date

4/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

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

Contacts

Covered Entity Signing Official

Jim McPherson, STD/HIV Program Manager
(408) 792-5032

Contract Pharmacy Representative

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

Signed By Date

1/3/2013

340B Drug Pricing Program Database