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CREDENA HEALTH PHARMACY TARZANA
DSH050761 TARZANA MEDICAL CENTER LLC DBA PROVIDENCE CEDARS SINAI TARZANA MEDICAL CENTER
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Covered Entity Details
Entity Name
TARZANA MEDICAL CENTER LLC DBA PROVIDENCE CEDARS SINAI TARZANA MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH050761
Entity Address
18321 CLARK STREET
TARZANA, CA 91356
Medicare Provider Number
050761
Participating Start Date
1/1/2012
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
CREDENA HEALTH PHARMACY TARZANA
Pharmacy Address
18370 BURBANK BLVD STE 104
TARZANA, CA 91356
Pharmacy Comments
Contract Details
Approval Date
1/8/2021
Contract Begin Date
1/8/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nick Lymberopoulos, Chief Operating Officer
(818) 708-5151
Contract Pharmacy Representative
Providence
Tammy Pierce, Director of Pharmacy
(503) 962-1700
Signed By Date
1/8/2021
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