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REGENCY MEDICAL PHARMACY
CH09365AG 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. - 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
REGENCY MEDICAL PHARMACY
Pharmacy Address
1000 NEWBURY RD STE 100
NEWBURY PARK, CA 91320-6436
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
Regency Medical Pharmacy
Raffi Svarjian, CFO
(805) 375-4050
Signed By Date
7/13/2023
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