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PHARMBLUE LLC DBA AVITA PHARMACY 1059
HV00791B Tarzana Treatment Centers, Inc.
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Covered Entity Details
Entity Name
Tarzana Treatment Centers, Inc.
Subdivision Name
Type
Ryan White Part C
340B ID
HV00791B
Entity Address
7101 Baird Ave
Reseda, CA 91335
Grant Number
H76HA00791
Participating Start Date
1/1/2013
Last Recertification Date
2/27/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
7/3/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ALBERT M. SENELLA, PRESIDENT AND CEO
(818) 654-3815
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
7/3/2017
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