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ENBORG LANE PHARMACY
CH098150 SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
SOUTH COUNTY COMMUNITY HEALTH CENTER, INC.
Subdivision Name
RAVENSWOOD FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH098150
Entity Address
1885 Bay Road
East Palo Alto, CA 94303-1312
Grant Number
H80CS00145
Participating Start Date
7/1/2002
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
ENBORG LANE PHARMACY
Pharmacy Address
2221 ENBORG LANE
1J018
SAN JOSE, CA 95128
Pharmacy Comments
Contract Details
Approval Date
4/11/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
LUISA BUADA, CEO
(650) 330-7410
Contract Pharmacy Representative
Santa Clara Valley Medical Center
Jecedthel Dumpit, 340B Pharmacist
(408) 885-4442
Signed By Date
4/11/2024
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