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MEDICAL PLAZA PHARMACY
CH09365AA 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. - Simi Valley
Type
HRSA-Funded Health Center
340B ID
CH09365AA
Entity Address
1424 Madera Rd
Simi Valley, CA 93065-3000
Grant Number
H80CS00550
Participating Start Date
10/1/2012
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEDICAL PLAZA PHARMACY
Pharmacy Address
SCRIPT COMPANY, INC. DBA
353 CENTRAL AVENUE
FILLMORE, CA 93015
Pharmacy Comments
Contract Details
Approval Date
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/22/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Robert Streeter, Chief Medical Officer
(805) 659-1740
Contract Pharmacy Representative
Roger's Pharmacy
Mukesh Rai, Owner
(805) 981-3366
Signed By Date
7/13/2023
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