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SANTA CLARA VALLEY MEDICAL CENTER
CH091181P SANTA CLARA, COUNTY OF
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Covered Entity Details
Entity Name
SANTA CLARA, COUNTY OF
Subdivision Name
HOMELESS DENTAL MOBILE UNIT
Type
HRSA-Funded Health Center
340B ID
CH091181P
Entity Address
500 Tully Rd
San Jose, CA 95111-1917
Grant Number
H80CS01442
Participating Start Date
1/1/2014
Last Recertification Date
2/9/2017
Entity Termination Date
4/1/2018
Pharmacy Details
Pharmacy Name
SANTA CLARA VALLEY MEDICAL CENTER
Pharmacy Address
DISCHARGE PHARMACY
751 SOUTH BASCOM AVE, MAIN HOSPITAL BUIL
SAN JOSE, CA 95128
Pharmacy Comments
Contract Details
Approval Date
7/7/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2018
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Paul Edward Lorenz, Chief Executive Officer
(408) 885-4004
Contract Pharmacy Representative
SCVMC
Narinder Singh, Director of Pharmacy
(408) 885-2300
Signed By Date
7/7/2016
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