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WALMART PHARMACY 10-5664
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
WALMART PHARMACY 10-5664
Pharmacy Address
275 WEST VENTURA BLVD.
CAMARILLO, CA 93010
Pharmacy Comments
Contract Details
Approval Date
4/8/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gagan Pawar, Chief Medical Officer
(805) 659-1740
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/8/2015
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