340B Drug Pricing Program Database


FQHCLA421C TARZANA TREATMENT CENTER, INC. (Active) - information as of 5/11/2025 11:35:24 PM

Main Details
TARZANA TREATMENT CENTER, INC.
Tarzana Treatment Centers-Palmdale
Health Center Program Look-Alike
BPS-LAL-031688
FQHCLA421C
LALCS40177


Additional Details
Active
1/28/2021
4/1/2021
3/5/2021
2/11/2025

Contacts

Tarzana Treatment Centers, Inc.
ALBERT M. SENELLA, PRESIDENT AND CEO
(818) 654-3815

Tarzana Treatment Centers, Inc.
Wendy De Santiago, Administrative Manager
(818) 654-3815

Addresses

320 E Palmdale Blvd
Palmdale, CA 93550-4598

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailCOUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260204/15/202107/01/2021  07/01/2021
Contract DetailENTREGA PHARMACY LLCDBA ENTREGA PHARMACY 44469 10TH ST W STE B
LANCASTERCA93534-332410/07/202110/08/2021  10/12/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 3055 38012 47TH STREET EAST
PALMDALECA9355207/07/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09634 2521 EAST AVENUE S
PALMDALECA9355007/07/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16206 39440 10TH ST W
PALMDALECA9355107/07/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17415 38019 47TH ST E
PALMDALECA9355207/07/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08876 233 EAST WILLOW STREET
LONG BEACHCA9080607/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16069 43525 10TH ST W
LANCASTERCA9353407/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09785 2006 WEST AVENUE J
LANCASTERCA9353607/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16097 8840 CORBIN AVE
NORTHRIDGECA9132407/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09657 44430 CHALLENGER WAY
LANCASTERCA9353507/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09601 1015 N. SAN FERNANDO BOULEVARD
BURBANKCA9150407/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09682 22968 VICTORY BLVD
WOODLAND HILLSCA9136707/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05022 7400 RESEDA BLVD.
RESEDACA9133507/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09615 19353 VICTORY BLVD.
RESEDACA9133507/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09706 9038 BALBOA BLVD.
NORTHRIDGECA9132507/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09642 8530 RESEDA BLVD.
NORTHRIDGECA9132407/15/202107/27/2021  07/27/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09605 10181 RESEDA BLVD.
NORTHRIDGECA9132407/15/202107/27/2021  07/27/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09670 18441 VENTURA BLVD
TARZANACA9135607/15/202107/27/2021  07/27/2021
Contract DetailMARKET PHARMACY9250 RESEDA BLVD STE 2C
NORTHRIDGECA91324-521507/14/202107/27/2021  07/27/2021
Contract DetailPMD PHARMACY LLCPMD PHARMACY 44469 10TH STREET W
SUITE B 		LANCASTERCA93534-935307/06/202107/27/2021 10/15/202110/15/2021
Contract DetailRX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135504/15/202107/01/2021  07/01/2021
Contract DetailWALGREEN CODBA: WALGREENS #01813 18568 VENTURA BLVD
TARZANACA9135607/15/202107/27/2021  07/27/2021
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15293 4940 VAN NUYS BLVD STE 104
SHERMAN OAKSCA9140304/08/202104/19/2021  04/19/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 06976 37160 47TH STREET EAST
PALMDALECA93552-445007/07/202107/27/2021  07/27/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 06018 831 E AVENUE K
LANCASTERCA9353507/15/202107/27/2021  07/27/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 06648 18430 SHERMAN WAY
RESEDACA91335-430507/15/202107/27/2021  07/27/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 06700 5224 COLDWATER CANYON AVE
VAN NUYSCA91401-614607/15/202107/27/2021  07/27/2021
Contract DetailWALGREEN CO.DBA: WALGREENS #10692 1834 W AVENUE J
LANCASTERCA9353407/15/202107/27/2021  07/27/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 07244 3570 ATLANTIC AVE
LONG BEACHCA90807-451607/15/202107/27/2021  07/27/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 06347 18515 DEVONSHIRE ST
NORTHRIDGECA9132407/15/202107/27/2021  07/27/2021
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21154 730-740 LONG BEACH BLVD
#A & #C 		LONG BEACHCA9081307/15/202107/27/2021  07/27/2021
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
FQHCLA421ActiveBPS-LAL-031691TARZANA TREATMENT CENTER, INC.Tarzana Treatment Centers-Northridge8330 Reseda Blvd NorthridgeCA
FQHCLA421AActiveBPS-LAL-031684TARZANA TREATMENT CENTER, INC.Tarzana Treatment Centers-Reseda7101 Baird Ave ResedaCA
FQHCLA421BActiveBPS-LAL-031689TARZANA TREATMENT CENTER, INC.Tarzana Treatment Centers- Antelope Valley Family Medical Clinic907 W Lancaster Blvd LancasterCA
FQHCLA421CActiveBPS-LAL-031688TARZANA TREATMENT CENTER, INC.Tarzana Treatment Centers-Palmdale320 E Palmdale Blvd PalmdaleCA
FQHCLA421DActiveBPS-LAL-031692TARZANA TREATMENT CENTER, INC.Primary Healthcare Services @ Tarzana Treatment Centers18646 Oxnard St TarzanaCA
FQHCLA421EActiveBPS-LAL-032159TARZANA TREATMENT CENTER, INC.Tarzana Treatment Centers - Atlantic Ave5190 Atlantic Ave Long BeachCA
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
FQHCLA421DCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361404/01/2021  
FQHCLA421DCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005604/01/2021  
FQHCLA421DCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621904/01/2021  
FQHCLA421DCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175704/01/2021  
FQHCLA421DCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808304/01/2021  
FQHCLA421DCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700404/01/2021  
FQHCLA421DCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761704/01/2021  
FQHCLA421DCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813304/01/2021  
FQHCLA421DCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237404/01/2021  
FQHCLA421DCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911904/01/2021  
FQHCLA421DCOUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260207/01/2021  
FQHCLA421COUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260207/01/2021  
FQHCLA421ACOUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260207/01/2021  
FQHCLA421BCOUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260207/01/2021  
FQHCLA421CCOUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260207/01/2021  
FQHCLA421ECOUNTY OF LOS ANGELES - AUDITOR CONTROLL313 N FIGUEROA ST STE 1225 HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELESCA90012-260207/01/2021  
FQHCLA421DCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502804/01/2021  
FQHCLA421CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/27/2021  
FQHCLA421ENTREGA PHARMACY LLCDBA ENTREGA PHARMACY 44469 10TH ST W STE B
LANCASTERCA93534-332410/08/2021  
FQHCLA421AENTREGA PHARMACY LLCDBA ENTREGA PHARMACY 44469 10TH ST W STE B
LANCASTERCA93534-332410/08/2021  
FQHCLA421BENTREGA PHARMACY LLCDBA ENTREGA PHARMACY 44469 10TH ST W STE B
LANCASTERCA93534-332410/08/2021  
FQHCLA421CENTREGA PHARMACY LLCDBA ENTREGA PHARMACY 44469 10TH ST W STE B
LANCASTERCA93534-332410/08/2021  
FQHCLA421DENTREGA PHARMACY LLCDBA ENTREGA PHARMACY 44469 10TH ST W STE B
LANCASTERCA93534-332410/08/2021  
FQHCLA421EENTREGA PHARMACY LLCDBA ENTREGA PHARMACY 44469 10TH ST W STE B
LANCASTERCA93534-332410/08/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09682 22968 VICTORY BLVD
WOODLAND HILLSCA9136704/01/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09615 19353 VICTORY BLVD.
RESEDACA9133504/01/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09601 1015 N. SAN FERNANDO BOULEVARD
BURBANKCA9150404/01/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09615 19353 VICTORY BLVD.
RESEDACA9133507/01/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09615 19353 VICTORY BLVD.
RESEDACA9133507/01/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09615 19353 VICTORY BLVD.
RESEDACA9133507/01/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05022 7400 RESEDA BLVD.
RESEDACA9133507/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09605 10181 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09642 8530 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09706 9038 BALBOA BLVD.
NORTHRIDGECA9132507/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16097 8840 CORBIN AVE
NORTHRIDGECA9132407/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 3055 38012 47TH STREET EAST
PALMDALECA9355207/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09634 2521 EAST AVENUE S
PALMDALECA9355007/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16206 39440 10TH ST W
PALMDALECA9355107/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17415 38019 47TH ST E
PALMDALECA9355207/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09785 2006 WEST AVENUE J
LANCASTERCA9353607/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16069 43525 10TH ST W
LANCASTERCA9353407/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08876 233 EAST WILLOW STREET
LONG BEACHCA9080607/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05022 7400 RESEDA BLVD.
RESEDACA9133507/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 3055 38012 47TH STREET EAST
PALMDALECA9355207/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09634 2521 EAST AVENUE S
PALMDALECA9355007/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16206 39440 10TH ST W
PALMDALECA9355107/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17415 38019 47TH ST E
PALMDALECA9355207/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09785 2006 WEST AVENUE J
LANCASTERCA9353607/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16069 43525 10TH ST W
LANCASTERCA9353407/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09657 44430 CHALLENGER WAY
LANCASTERCA9353507/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08876 233 EAST WILLOW STREET
LONG BEACHCA9080607/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09601 1015 N. SAN FERNANDO BOULEVARD
BURBANKCA9150407/27/2021  
FQHCLA421GARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09682 22968 VICTORY BLVD
WOODLAND HILLSCA9136707/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09601 1015 N. SAN FERNANDO BOULEVARD
BURBANKCA9150407/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09682 22968 VICTORY BLVD
WOODLAND HILLSCA9136707/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09605 10181 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08876 233 EAST WILLOW STREET
LONG BEACHCA9080607/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17415 38019 47TH ST E
PALMDALECA9355207/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16206 39440 10TH ST W
PALMDALECA9355107/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16069 43525 10TH ST W
LANCASTERCA9353407/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16097 8840 CORBIN AVE
NORTHRIDGECA9132407/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 3055 38012 47TH STREET EAST
PALMDALECA9355207/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09634 2521 EAST AVENUE S
PALMDALECA9355007/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09785 2006 WEST AVENUE J
LANCASTERCA9353607/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09657 44430 CHALLENGER WAY
LANCASTERCA9353507/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09706 9038 BALBOA BLVD.
NORTHRIDGECA9132507/27/2021  
FQHCLA421AGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09642 8530 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17415 38019 47TH ST E
PALMDALECA9355207/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09634 2521 EAST AVENUE S
PALMDALECA9355007/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16206 39440 10TH ST W
PALMDALECA9355107/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16097 8840 CORBIN AVE
NORTHRIDGECA9132407/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 3055 38012 47TH STREET EAST
PALMDALECA9355207/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09657 44430 CHALLENGER WAY
LANCASTERCA9353507/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09601 1015 N. SAN FERNANDO BOULEVARD
BURBANKCA9150407/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09682 22968 VICTORY BLVD
WOODLAND HILLSCA9136707/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05022 7400 RESEDA BLVD.
RESEDACA9133507/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09706 9038 BALBOA BLVD.
NORTHRIDGECA9132507/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09642 8530 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08876 233 EAST WILLOW STREET
LONG BEACHCA9080607/27/2021  
FQHCLA421BGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09605 10181 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08876 233 EAST WILLOW STREET
LONG BEACHCA9080607/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16069 43525 10TH ST W
LANCASTERCA9353407/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09785 2006 WEST AVENUE J
LANCASTERCA9353607/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16097 8840 CORBIN AVE
NORTHRIDGECA9132407/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09657 44430 CHALLENGER WAY
LANCASTERCA9353507/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09601 1015 N. SAN FERNANDO BOULEVARD
BURBANKCA9150407/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09682 22968 VICTORY BLVD
WOODLAND HILLSCA9136707/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05022 7400 RESEDA BLVD.
RESEDACA9133507/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09615 19353 VICTORY BLVD.
RESEDACA9133507/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09706 9038 BALBOA BLVD.
NORTHRIDGECA9132507/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09642 8530 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421CGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09605 10181 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17415 38019 47TH ST E
PALMDALECA9355207/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 08876 233 EAST WILLOW STREET
LONG BEACHCA9080607/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16206 39440 10TH ST W
PALMDALECA9355107/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16069 43525 10TH ST W
LANCASTERCA9353407/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16097 8840 CORBIN AVE
NORTHRIDGECA9132407/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09605 10181 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09642 8530 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09706 9038 BALBOA BLVD.
NORTHRIDGECA9132507/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05022 7400 RESEDA BLVD.
RESEDACA9133507/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09657 44430 CHALLENGER WAY
LANCASTERCA9353507/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09785 2006 WEST AVENUE J
LANCASTERCA9353607/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09634 2521 EAST AVENUE S
PALMDALECA9355007/27/2021  
FQHCLA421DGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 3055 38012 47TH STREET EAST
PALMDALECA9355207/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09605 10181 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09642 8530 RESEDA BLVD.
NORTHRIDGECA9132407/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09706 9038 BALBOA BLVD.
NORTHRIDGECA9132507/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09615 19353 VICTORY BLVD.
RESEDACA9133507/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 05022 7400 RESEDA BLVD.
RESEDACA9133507/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09682 22968 VICTORY BLVD
WOODLAND HILLSCA9136707/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09601 1015 N. SAN FERNANDO BOULEVARD
BURBANKCA9150407/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09657 44430 CHALLENGER WAY
LANCASTERCA9353507/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09785 2006 WEST AVENUE J
LANCASTERCA9353607/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA: CVS/PHARMACY # 09634 2521 EAST AVENUE S
PALMDALECA9355007/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 3055 38012 47TH STREET EAST
PALMDALECA9355207/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16097 8840 CORBIN AVE
NORTHRIDGECA9132407/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16069 43525 10TH ST W
LANCASTERCA9353407/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16206 39440 10TH ST W
PALMDALECA9355107/27/2021  
FQHCLA421EGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 17415 38019 47TH ST E
PALMDALECA9355207/27/2021  
FQHCLA421DLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09670 18441 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421LONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09670 18441 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421ALONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09670 18441 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421BLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09670 18441 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421CLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09670 18441 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421ELONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09670 18441 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421MARKET PHARMACY9250 RESEDA BLVD STE 2C
NORTHRIDGECA91324-521507/27/2021  
FQHCLA421AMARKET PHARMACY9250 RESEDA BLVD STE 2C
NORTHRIDGECA91324-521507/27/2021  
FQHCLA421DMARKET PHARMACY9250 RESEDA BLVD STE 2C
NORTHRIDGECA91324-521507/27/2021  
FQHCLA421BMARKET PHARMACY9250 RESEDA BLVD STE 2C
NORTHRIDGECA91324-521507/27/2021  
FQHCLA421CMARKET PHARMACY9250 RESEDA BLVD STE 2C
NORTHRIDGECA91324-521507/27/2021  
FQHCLA421EMARKET PHARMACY9250 RESEDA BLVD STE 2C
NORTHRIDGECA91324-521507/27/2021  
FQHCLA421BPMD PHARMACY LLCPMD PHARMACY 44469 10TH STREET W
SUITE B 		LANCASTERCA93534-935307/27/2021 10/15/2021
FQHCLA421CPMD PHARMACY LLCPMD PHARMACY 44469 10TH STREET W
SUITE B 		LANCASTERCA93534-935307/27/2021 10/15/2021
FQHCLA421PMD PHARMACY LLCPMD PHARMACY 44469 10TH STREET W
SUITE B 		LANCASTERCA93534-935307/27/2021 10/15/2021
FQHCLA421APMD PHARMACY LLCPMD PHARMACY 44469 10TH STREET W
SUITE B 		LANCASTERCA93534-935307/27/2021 10/15/2021
FQHCLA421DPMD PHARMACY LLCPMD PHARMACY 44469 10TH STREET W
SUITE B 		LANCASTERCA93534-935307/27/2021 10/15/2021
FQHCLA421EPMD PHARMACY LLCPMD PHARMACY 44469 10TH STREET W
SUITE B 		LANCASTERCA93534-935307/27/2021 10/15/2021
FQHCLA421DPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514604/01/2021  
FQHCLA421DPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1 		HONOLULUHI9681304/01/2021  
FQHCLA421DPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523304/01/2021  
FQHCLA421DPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY 8607 SANTA MONICA BOULEVARD
WEST HOLLYWOODCA9006904/01/2021  
FQHCLA421DRX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135507/01/2021  
FQHCLA421RX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135507/01/2021  
FQHCLA421ARX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135507/01/2021  
FQHCLA421BRX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135507/01/2021  
FQHCLA421CRX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135507/01/2021  
FQHCLA421ERX E-FILL SOLUTIONSCARDINAL HEALTH PHARMACY SERVICES, LLC 27680 AVENUE MENTRY STE 100
VALENCIACA9135507/01/2021  
FQHCLA421DWALGREEN CODBA: WALGREENS #01813 18568 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421WALGREEN CODBA: WALGREENS #01813 18568 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421AWALGREEN CODBA: WALGREENS #01813 18568 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421BWALGREEN CODBA: WALGREENS #01813 18568 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421CWALGREEN CODBA: WALGREENS #01813 18568 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421EWALGREEN CODBA: WALGREENS #01813 18568 VENTURA BLVD
TARZANACA9135607/27/2021  
FQHCLA421AWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15293 4940 VAN NUYS BLVD STE 104
SHERMAN OAKSCA9140304/19/2021  
FQHCLA421WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15293 4940 VAN NUYS BLVD STE 104
SHERMAN OAKSCA9140304/19/2021  
FQHCLA421BWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15293 4940 VAN NUYS BLVD STE 104
SHERMAN OAKSCA9140304/19/2021  
FQHCLA421CWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15293 4940 VAN NUYS BLVD STE 104
SHERMAN OAKSCA9140304/19/2021  
FQHCLA421EWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15293 4940 VAN NUYS BLVD STE 104
SHERMAN OAKSCA9140304/19/2021  
FQHCLA421EWALGREEN CO.DBA: WALGREENS # 07244 3570 ATLANTIC AVE
LONG BEACHCA90807-451607/27/2021  
FQHCLA421EWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21154 730-740 LONG BEACH BLVD
#A & #C 		LONG BEACHCA9081307/27/2021  
FQHCLA421AWALGREEN CO.DBA: WALGREENS # 06648 18430 SHERMAN WAY
RESEDACA91335-430507/27/2021  
FQHCLA421WALGREEN CO.DBA: WALGREENS # 06347 18515 DEVONSHIRE ST
NORTHRIDGECA9132407/27/2021  
FQHCLA421CWALGREEN CO.DBA: WALGREENS # 06976 37160 47TH STREET EAST
PALMDALECA93552-445007/27/2021  
FQHCLA421BWALGREEN CO.DBA: WALGREENS # 06018 831 E AVENUE K
LANCASTERCA9353507/27/2021  
FQHCLA421WALGREEN CO.DBA: WALGREENS # 06976 37160 47TH STREET EAST
PALMDALECA93552-445007/27/2021  
FQHCLA421WALGREEN CO.DBA: WALGREENS # 06018 831 E AVENUE K
LANCASTERCA9353507/27/2021  
FQHCLA421WALGREEN CO.DBA: WALGREENS # 07244 3570 ATLANTIC AVE
LONG BEACHCA90807-451607/27/2021  
FQHCLA421WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21154 730-740 LONG BEACH BLVD
#A & #C 		LONG BEACHCA9081307/27/2021  
FQHCLA421WALGREEN CO.DBA: WALGREENS # 06648 18430 SHERMAN WAY
RESEDACA91335-430507/27/2021  
FQHCLA421WALGREEN CO.DBA: WALGREENS # 06700 5224 COLDWATER CANYON AVE
VAN NUYSCA91401-614607/27/2021  
FQHCLA421WALGREEN CO.DBA: WALGREENS #10692 1834 W AVENUE J
LANCASTERCA9353407/27/2021  
FQHCLA421AWALGREEN CO.DBA: WALGREENS # 06018 831 E AVENUE K
LANCASTERCA9353507/27/2021  
FQHCLA421AWALGREEN CO.DBA: WALGREENS # 06700 5224 COLDWATER CANYON AVE
VAN NUYSCA91401-614607/27/2021  
FQHCLA421AWALGREEN CO.DBA: WALGREENS #10692 1834 W AVENUE J
LANCASTERCA9353407/27/2021  
FQHCLA421BWALGREEN CO.DBA: WALGREENS # 06648 18430 SHERMAN WAY
RESEDACA91335-430507/27/2021  
FQHCLA421BWALGREEN CO.DBA: WALGREENS # 06700 5224 COLDWATER CANYON AVE
VAN NUYSCA91401-614607/27/2021  
FQHCLA421BWALGREEN CO.DBA: WALGREENS #10692 1834 W AVENUE J
LANCASTERCA9353407/27/2021  
FQHCLA421CWALGREEN CO.DBA: WALGREENS # 06018 831 E AVENUE K
LANCASTERCA9353507/27/2021  
FQHCLA421CWALGREEN CO.DBA: WALGREENS # 06648 18430 SHERMAN WAY
RESEDACA91335-430507/27/2021  
FQHCLA421CWALGREEN CO.DBA: WALGREENS # 06700 5224 COLDWATER CANYON AVE
VAN NUYSCA91401-614607/27/2021  
FQHCLA421CWALGREEN CO.DBA: WALGREENS #10692 1834 W AVENUE J
LANCASTERCA9353407/27/2021  
FQHCLA421DWALGREEN CO.DBA: WALGREENS # 06018 831 E AVENUE K
LANCASTERCA9353507/27/2021  
FQHCLA421DWALGREEN CO.DBA: WALGREENS # 06648 18430 SHERMAN WAY
RESEDACA91335-430507/27/2021  
FQHCLA421DWALGREEN CO.DBA: WALGREENS # 06700 5224 COLDWATER CANYON AVE
VAN NUYSCA91401-614607/27/2021  
FQHCLA421DWALGREEN CO.DBA: WALGREENS #10692 1834 W AVENUE J
LANCASTERCA9353407/27/2021  
FQHCLA421DWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #15293 4940 VAN NUYS BLVD STE 104
SHERMAN OAKSCA9140307/27/2021  
FQHCLA421EWALGREEN CO.DBA: WALGREENS # 06018 831 E AVENUE K
LANCASTERCA9353507/27/2021  
FQHCLA421EWALGREEN CO.DBA: WALGREENS # 06648 18430 SHERMAN WAY
RESEDACA91335-430507/27/2021  
FQHCLA421EWALGREEN CO.DBA: WALGREENS # 06700 5224 COLDWATER CANYON AVE
VAN NUYSCA91401-614607/27/2021  
FQHCLA421EWALGREEN CO.DBA: WALGREENS #10692 1834 W AVENUE J
LANCASTERCA9353407/27/2021  
FQHCLA421AWALGREEN CO.DBA: WALGREENS # 06347 18515 DEVONSHIRE ST
NORTHRIDGECA9132407/27/2021  
FQHCLA421AWALGREEN CO.DBA: WALGREENS # 06976 37160 47TH STREET EAST
PALMDALECA93552-445007/27/2021  
FQHCLA421AWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21154 730-740 LONG BEACH BLVD
#A & #C 		LONG BEACHCA9081307/27/2021  
FQHCLA421AWALGREEN CO.DBA: WALGREENS # 07244 3570 ATLANTIC AVE
LONG BEACHCA90807-451607/27/2021  
FQHCLA421BWALGREEN CO.DBA: WALGREENS # 06976 37160 47TH STREET EAST
PALMDALECA93552-445007/27/2021  
FQHCLA421BWALGREEN CO.DBA: WALGREENS # 07244 3570 ATLANTIC AVE
LONG BEACHCA90807-451607/27/2021  
FQHCLA421BWALGREEN CO.DBA: WALGREENS # 06347 18515 DEVONSHIRE ST
NORTHRIDGECA9132407/27/2021  
FQHCLA421BWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21154 730-740 LONG BEACH BLVD
#A & #C 		LONG BEACHCA9081307/27/2021  
FQHCLA421CWALGREEN CO.DBA: WALGREENS # 07244 3570 ATLANTIC AVE
LONG BEACHCA90807-451607/27/2021  
FQHCLA421CWALGREEN CO.DBA: WALGREENS # 06347 18515 DEVONSHIRE ST
NORTHRIDGECA9132407/27/2021  
FQHCLA421CWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21154 730-740 LONG BEACH BLVD
#A & #C 		LONG BEACHCA9081307/27/2021  
FQHCLA421DWALGREEN CO.DBA: WALGREENS # 06976 37160 47TH STREET EAST
PALMDALECA93552-445007/27/2021  
FQHCLA421DWALGREEN CO.DBA: WALGREENS # 07244 3570 ATLANTIC AVE
LONG BEACHCA90807-451607/27/2021  
FQHCLA421DWALGREEN CO.DBA: WALGREENS # 06347 18515 DEVONSHIRE ST
NORTHRIDGECA9132407/27/2021  
FQHCLA421DWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #21154 730-740 LONG BEACH BLVD
#A & #C 		LONG BEACHCA9081307/27/2021  
FQHCLA421EWALGREEN CO.DBA: WALGREENS # 06976 37160 47TH STREET EAST
PALMDALECA93552-445007/27/2021  
FQHCLA421EWALGREEN CO.DBA: WALGREENS # 06347 18515 DEVONSHIRE ST
NORTHRIDGECA9132407/27/2021  
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/4/2024 10:55:55 PM2/11/2025 1:51:54 AM2/11/2025 1:51 AM
DetailsLast Recertification DateUpdateRecertification2/8/2023 12:54:07 AM2/4/2024 10:55:55 PM2/4/2024 10:55 PM
Medicaid BillingNPI: NumberInsertRecertification 12859303962/8/2023 12:54 AM
Medicaid BillingNPI: StateInsertRecertification CA2/8/2023 12:54 AM
DetailsLast Recertification DateUpdateRecertification2/6/2022 1:01:02 AM2/8/2023 12:54:07 AM2/8/2023 12:54 AM
DetailsLast Recertification DateUpdateRecertification 2/6/2022 1:01:02 AM2/6/2022 1:01 AM
DetailsStateUpdate ApprovedActive4/1/2021 12:01 AM
ContactsPrimary ContactUpdateChange RequestPrice, Shelley Admin Manager Tarzana Treatment Centers, Inc. 8186543815De Santiago, Wendy Administrative Manager Tarzana Treatment Centers, Inc. 81865438153/11/2021 1:17 PM
ContactsSigned ByInsertNew Registration SENELLA, ALBERT M. PRESIDENT AND CEO Tarzana Treatment Centers, Inc. 81865438153/5/2021 3:20 PM
Details340B IDUpdateNew Registration FQHCLA421C3/5/2021 3:20 PM
DatesParticipating Approval DateUpdateNew Registration 3/5/2021 3:20:07 PM3/5/2021 3:20 PM
DetailsStateUpdateNew RegistrationPendingApproved3/5/2021 3:20 PM
DatesSigned By DateUpdateNew Registration 1/29/2021 1:22:37 PM3/5/2021 3:20 PM
DatesStart DateUpdateNew Registration 4/1/2021 12:00:00 AM3/5/2021 3:20 PM
AddressesMain AddressInsertNew Registration  320 E Palmdale Blvd Palmdale, CA 93550-45981/28/2021 11:28 AM
ContactsAuthorizing OfficialInsertNew Registration SENELLA, ALBERT M. PRESIDENT AND CEO Tarzana Treatment Centers, Inc. 81865438151/28/2021 11:28 AM
ContactsPrimary ContactInsertNew Registration Price, Shelley Admin Manager Tarzana Treatment Centers, Inc. 81865438151/28/2021 11:28 AM
DetailsAssistance Received From DateInsertNew Registration  1/28/2021 11:28 AM
DetailsAssistance Received To DateInsertNew Registration  1/28/2021 11:28 AM
DetailsLast Recertification DateInsertNew Registration  1/28/2021 11:28 AM
DetailsGrant NumberInsertNew Registration LALCS401771/28/2021 11:28 AM
Details340B IDInsertNew Registration  1/28/2021 11:28 AM
DetailsIs Authorizing Official EHB DataInsertNew Registration  1/28/2021 11:28 AM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  1/28/2021 11:28 AM
DetailsMedicare Provider NumberInsertNew Registration  1/28/2021 11:28 AM
DetailsEntity NameInsertNew Registration TARZANA TREATMENT CENTER, INC.1/28/2021 11:28 AM
DetailsNOFO NumberInsertNew Registration  1/28/2021 11:28 AM
DetailsProgram CodeInsertNew Registration FQHCLA1/28/2021 11:28 AM
DetailsEntity SubnameInsertNew Registration Tarzana Treatment Centers-Palmdale1/28/2021 11:28 AM
DatesParticipating Approval DateInsertNew Registration  1/28/2021 11:28 AM
DetailsStateInsertNew Registration Pending1/28/2021 11:28 AM
DatesRegistration DateInsertNew Registration 1/28/2021 11:28:56 AM1/28/2021 11:28 AM
DatesSigned By DateInsertNew Registration  1/28/2021 11:28 AM
DatesStart DateInsertNew Registration  1/28/2021 11:28 AM
TerminationsTermination CommentsInsertNew Registration  1/28/2021 11:28 AM
TerminationsTermination DateInsertNew Registration  1/28/2021 11:28 AM
TerminationsTermination Effective DateInsertNew Registration  1/28/2021 11:28 AM
TerminationsTermination ReasonInsertNew Registration  1/28/2021 11:28 AM