Contract Pharmacy Details

WALGREEN CO.
FQHCLA421D TARZANA TREATMENT CENTER, INC.

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 # 06700
5224 COLDWATER CANYON AVE
VAN NUYS, CA 91401-6146

Pharmacy Comments

Contract Details

Approval Date

7/15/2021

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

7/15/2021

340B Drug Pricing Program Database