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MEDICAL PLAZA PHARMACY
CH09365AB 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. - East Simi Valley
Type
HRSA-Funded Health Center
340B ID
CH09365AB
Entity Address
4370 Eve Road
Simi Valley, CA 93063-2323
Grant Number
H80CS00550
Participating Start Date
7/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MEDICAL PLAZA PHARMACY
Pharmacy Address
SCRIPT COMPANY, INC. DBA
353 CENTRAL AVENUE
FILLMORE, CA 93015
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Gagan Pawar, Chief Medical Officer
(805) 659-1740
Contract Pharmacy Representative
Roger's Pharmacy
Mukesh Rai, Owner
(805) 981-3366
Signed By Date
4/13/2015
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