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RALPHS GROCERY CO.
CH09365A 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 - Fillmore
Type
HRSA-Funded Health Center
340B ID
CH09365A
Entity Address
355 Central Ave
Fillmore, CA 93015-1920
Grant Number
H80CS00550
Participating Start Date
7/1/1995
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
RALPHS GROCERY CO.
Pharmacy Address
DBA RALPHS #096
160 NORTH LAKE AVE
PASADENA, CA 91101
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/24/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Streeter, Chief Medical Officer
(805) 659-1740
Contract Pharmacy Representative
Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109
Signed By Date
7/17/2023
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