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WALMART PHARMACY 10-5169
CH09365F 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 Inc - Santa Paula
Type
HRSA-Funded Health Center
340B ID
CH09365F
Entity Address
500 E. Main Street
Santa Paula, CA 93060-2607
Grant Number
H80CS00550
Participating Start Date
4/1/2008
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
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
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
7/13/2023
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