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WAL-MART PHARMACY 10-2032
CH09848O COUNTY OF VENTURA
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Covered Entity Details
Entity Name
COUNTY OF VENTURA
Subdivision Name
Moorpark Family Medical Clinic
Type
HRSA-Funded Health Center
340B ID
CH09848O
Entity Address
612 Spring Road BLDG A
Moorpark, CA 93021
Grant Number
H80CS00247
Participating Start Date
10/9/2008
Last Recertification Date
3/4/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2032
Pharmacy Address
2001 NORTH ROSE AVENUE
OXNARD, CA 93036
Pharmacy Comments
Contract Details
Approval Date
1/14/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joan Araujo, Deputy Director
(805) 677-5174
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
1/14/2015
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