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COUNTY OF LOS ANGELES - AUDITOR CONTROLL
FQHCLA421D TARZANA TREATMENT CENTER, INC.
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Covered Entity Details
Entity Name
TARZANA TREATMENT CENTER, INC.
Subdivision Name
Primary Healthcare Services @ Tarzana Treatment Centers
Type
Health Center Program Look-Alike
340B ID
FQHCLA421D
Entity Address
18646 Oxnard St
Tarzana, CA 91356-1411
Grant Number
LALCS40177
Participating Start Date
4/1/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
COUNTY OF LOS ANGELES - AUDITOR CONTROLL
Pharmacy Address
313 N FIGUEROA ST STE 1225
HEALTH SERVICES CENTRAL PHARMACY
LOS ANGELES, CA 90012-2602
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
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
LA County DHS
Rabeah Elbanna, Pharmacy Supervisor I
(213) 288-7717
Signed By Date
4/15/2021
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