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ENBORG LANE PHARMACY
CH091181V SANTA CLARA, COUNTY OF
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Covered Entity Details
Entity Name
SANTA CLARA, COUNTY OF
Subdivision Name
Valley Health Center Downtown
Type
HRSA-Funded Health Center
340B ID
CH091181V
Entity Address
777 E Santa Clara St
San Jose, CA 95112
Grant Number
H80CS01442
Participating Start Date
10/1/2016
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
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/6/2018
Business decision by covered entity and/or pharmacy
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
7/15/2016
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