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ENTREGA PHARMACY LLC
FQHCLA421C TARZANA TREATMENT CENTER, INC.
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Covered Entity Details
Entity Name
TARZANA TREATMENT CENTER, INC.
Subdivision Name
Tarzana Treatment Centers-Palmdale
Type
Health Center Program Look-Alike
340B ID
FQHCLA421C
Entity Address
320 E Palmdale Blvd
Palmdale, CA 93550-4598
Grant Number
LALCS40177
Participating Start Date
4/1/2021
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
ENTREGA PHARMACY LLC
Pharmacy Address
DBA ENTREGA PHARMACY
44469 10TH ST W STE B
LANCASTER, CA 93534-3324
Pharmacy Comments
Contract Details
Approval Date
10/7/2021
Contract Begin Date
10/8/2021
Carve-In Effective Date
Contract Comments
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
10/7/2021
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