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WOOD RANCH PHARMACY & COMPOUNDING CENTER
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
WOOD RANCH PHARMACY & COMPOUNDING CENTER
Pharmacy Address
1464 MADERA RD # I-2
SIMI VALLEY, CA 93065
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
Wood Ranch Pharmacy & Compounding Center
Sarang Fatery, PIC/President
(805) 426-9500
Signed By Date
7/13/2023
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