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WAL-MART PHARMACY 10-2032
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
WAL-MART PHARMACY 10-2032
Pharmacy Address
2001 NORTH ROSE AVENUE
OXNARD, CA 93036
Pharmacy Comments
Contract Details
Approval Date
4/13/2015
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
Walmart
Kathi Phelps, Manager Contracting & Channel Management
(479) 227-3719
Signed By Date
4/13/2015
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