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MARKET PHARMACY
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
MARKET PHARMACY
Pharmacy Address
9250 RESEDA BLVD STE 2C
NORTHRIDGE, CA 91324-5215
Pharmacy Comments
Contract Details
Approval Date
7/6/2021
Contract Begin Date
7/27/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALBERT M. SENELLA, PRESIDENT AND CEO
(818) 654-3815
Contract Pharmacy Representative
Market Pharmacy
ARMEN TATEVOSSIAN, PHARMACIST
(818) 701-7777
Signed By Date
7/6/2021
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