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WALGREEN CO
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
WALGREEN CO
Pharmacy Address
DBA: WALGREENS #01813
18568 VENTURA BLVD
TARZANA, CA 91356
Pharmacy Comments
Contract Details
Approval Date
7/7/2021
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
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/7/2021
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