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WALMART PHARMACY 10-3179
CH09365AM 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 Optical
Type
HRSA-Funded Health Center
340B ID
CH09365AM
Entity Address
1000 Newbury Rd Ste 170
Newbury Park, CA 91320-6439
Grant Number
H80CS00550
Participating Start Date
4/1/2021
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-3179
Pharmacy Address
512 NORTH VENTU PARK RD
THOUSAND OAKS, CA 91320
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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