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GARFIELD BEACH CVS, L.L.C.
FQHCLA421E TARZANA TREATMENT CENTER, INC.
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Covered Entity Details
Entity Name
TARZANA TREATMENT CENTER, INC.
Subdivision Name
Tarzana Treatment Centers - Atlantic Ave
Type
Health Center Program Look-Alike
340B ID
FQHCLA421E
Entity Address
5190 Atlantic Ave
Long Beach, CA 90805-6510
Grant Number
LALCS40177
Participating Start Date
4/19/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
GARFIELD BEACH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 09601
1015 N. SAN FERNANDO BOULEVARD
BURBANK, CA 91504
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
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