Contract Pharmacy Details

GARFIELD BEACH CVS, L.L.C.
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

GARFIELD BEACH CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 09642
8530 RESEDA BLVD.
NORTHRIDGE, CA 91324

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

Wellpartner
Vittoria Porter, Sr. Account Manager
(480) 459-1262

Signed By Date

7/15/2021

340B Drug Pricing Program Database