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GARFIELD BEACH CVS, L.L.C.
FQHCLA421A TARZANA TREATMENT CENTER, INC.
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Covered Entity Details
Entity Name
TARZANA TREATMENT CENTER, INC.
Subdivision Name
Tarzana Treatment Centers-Reseda
Type
Health Center Program Look-Alike
340B ID
FQHCLA421A
Entity Address
7101 Baird Ave
Reseda, CA 91335-4150
Grant Number
LALCS40177
Participating Start Date
4/1/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09615
19353 VICTORY BLVD.
RESEDA, CA 91335
Pharmacy Comments
Contract Details
Approval Date
4/1/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALBERT M. SENELLA, PRESIDENT AND CEO
(818) 654-3815
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/1/2021
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