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CYSTIC FIBROSIS SERVICES, LLC
CH09365Z CLINICAS DEL CAMINO REAL, INC.
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Covered Entity Details
Entity Name
CLINICAS DEL CAMINO REAL, INC.
Subdivision Name
Clinicas del Camino Real, Incorporated - Moorpark
Type
HRSA-Funded Health Center
340B ID
CH09365Z
Entity Address
4279 Tierra Rejada Rd
Moorpark, CA 93021-3775
Grant Number
H80CS00550
Participating Start Date
10/1/2012
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
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
Walgreens
Karl Mechan, Vice President Health Systems Programs
(847) 315-2663
Signed By Date
7/13/2023
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