Contract Pharmacy Details

LONGS DRUG STORES CALIFORNIA, L.L.C.
CH09365A CLINICAS DEL CAMINO REAL, INC.

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

LONGS DRUG STORES CALIFORNIA, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09286
581 W CHANNEL ISLANDS BLVD
PORT HUENEME, CA 93041

Pharmacy Comments

01/27/2012 changed CP name (was LONGS DRUGS #286)

Contract Details

Approval Date

10/15/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Gagan Pawar, Chief Medical Officer
(805) 659-1740

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/15/2015

340B Drug Pricing Program Database