Contract Pharmacy Details

PMD PHARMACY LLC
FQHCLA421B TARZANA TREATMENT CENTER, INC.

Covered Entity Details

Entity Name

TARZANA TREATMENT CENTER, INC.

Subdivision Name

Tarzana Treatment Centers- Antelope Valley Family Medical Clinic

Type

Health Center Program Look-Alike

340B ID

FQHCLA421B

Entity Address

907 W Lancaster Blvd
Lancaster, CA 93534-2305

Grant Number

LALCS40177

Participating Start Date

4/1/2021

Last Recertification Date

2/27/2025

Pharmacy Details

Pharmacy Name

PMD PHARMACY LLC

Pharmacy Address

PMD PHARMACY
44469 10TH STREET W
SUITE B
LANCASTER, CA 93534-9353

Pharmacy Comments

Contract Details

Approval Date

7/6/2021

Contract Begin Date

7/27/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/15/2021
Ownership change

Contacts

Covered Entity Signing Official

ALBERT M. SENELLA, PRESIDENT AND CEO
(818) 654-3815

Contract Pharmacy Representative

PMD Pharmacy #1
Minh Tran, Pharmacy POC
(571) 454-8174

Signed By Date

7/6/2021

340B Drug Pricing Program Database