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PMD PHARMACY LLC
RWI93551 TARZANA TREATMENT CENTERS, INC.
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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
PMD PHARMACY LLC
Pharmacy Address
PMD PHARMACY
44469 10TH STREET W
SUITE B
LANCASTER, CA 93534-9353
Pharmacy Comments
Contract Details
Approval Date
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2021
Ownership change
Contacts
Covered Entity Signing Official
ALBERT M. SENELLA, PRESIDENT AND CEO
(818) 654-3815
Contract Pharmacy Representative
Phuong Tran, President
(661) 579-2099
Signed By Date
7/11/2017
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