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VALLEY HEALTH CENTER AT SAN JOSE PHARMAC
RWI95128 IRA GREENE PACE CLINIC
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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
VALLEY HEALTH CENTER AT SAN JOSE PHARMAC
Pharmacy Address
750 SOUTH BASCOM AVE
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
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