Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09365AG CLINICAS DEL CAMINO REAL, INC.

Covered Entity Details

Entity Name

CLINICAS DEL CAMINO REAL, INC.

Subdivision Name

Clinicas Del Camino Real, Inc. - Newbury Park Dental

Type

HRSA-Funded Health Center

340B ID

CH09365AG

Entity Address

1000 Newbury Rd Suite 195
Newbury Park, CA 91320-6440

Grant Number

H80CS00550

Participating Start Date

4/1/2017

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09969
7850 TELEGRAPH RD
VENTURA, CA 93004

Pharmacy Comments

Contract Details

Approval Date

7/13/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Robert Streeter, Chief Medical Officer
(805) 659-1740

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/13/2023

340B Drug Pricing Program Database