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VHC AT TULLY PHARMACY
DSH050038 SANTA CLARA VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
SANTA CLARA VALLEY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050038
Entity Address
751 SOUTH BASCOM AVE.
SAN JOSE, CA 95128
Medicare Provider Number
050038
Participating Start Date
7/1/2001
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
VHC AT TULLY PHARMACY
Pharmacy Address
500 TULLY ROAD
SAN JOSE, CA 95111
Pharmacy Comments
Contract Details
Approval Date
4/30/2010
Contract Begin Date
5/1/2010
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
Contract Pharmacy Representative
Signed By Date
4/9/2010
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