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WALMART PHARMACY 10-3179
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
WALMART PHARMACY 10-3179
Pharmacy Address
512 NORTH VENTU PARK RD
THOUSAND OAKS, CA 91320
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
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/13/2015
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