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REGENCY MEDICAL PHARMACY
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
REGENCY MEDICAL PHARMACY
Pharmacy Address
1000 NEWBURY RD STE 100
NEWBURY PARK, CA 91320-6436
Pharmacy Comments
Contract Details
Approval Date
4/14/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gagan Pawar, Chief Medical Officer
(805) 659-1740
Contract Pharmacy Representative
Regency Medical Pharmacy
Raffi Svarjian, CFO
(805) 375-4050
Signed By Date
4/14/2017
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