Contract Pharmacy Details

WALGREEN CO.
RWI93551 TARZANA TREATMENT CENTERS, INC.

Covered Entity Details

Entity Name

TARZANA TREATMENT CENTERS, INC.

Subdivision Name

HIV CLINIC

Type

Ryan White Part A

340B ID

RWI93551

Entity Address

320 E. Palmdale Blvd.
PALMDALE, CA 93550

Grant Number

H76HA00791

Participating Start Date

7/1/2011

Last Recertification Date

2/27/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 06018
831 E AVENUE K
LANCASTER, CA 93535

Pharmacy Comments

Contract Details

Approval Date

4/9/2014

Contract Begin Date

7/1/2014

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

4/9/2014

340B Drug Pricing Program Database