| Details | Last Recertification Date | Update | Recertification | 2/26/2024 6:56:39 AM | 2/17/2025 5:19:04 PM | 2/17/2025 5:19 PM |
| Contacts | Primary Contact | Update | Recertification | Meehan, Thomas D.
Chief Pharmacist
Sault Ste. Marie Tribal Health
9066325226 | Goudreau, Danielle
Chief Pharmacist
Sault Ste. Marie Tribal Health
9063416993 | 2/26/2024 6:56 AM |
| Details | Last Recertification Date | Update | Recertification | 2/14/2023 4:40:05 PM | 2/26/2024 6:56:39 AM | 2/26/2024 6:56 AM |
| Addresses | Main Address | Update | Change Request |
5698 W US-2
MANISTIQUE, MI 49854 |
5698W US Highway 2
Manistique, MI 49854 | 2/22/2023 7:46 AM |
| Addresses | Shipping Address | Update | Change Request | SAULT STE. MARIE TRIBAL HEALTH PHARMACY
5698 W US-2
MANISTIQUE, MI 49854 | Sault Ste. Marie Tribal Health Pharmacy
5698W US Highway 2
Manistique, MI 49854 | 2/22/2023 7:46 AM |
| Details | Entity Name | Update | Change Request | SAULT STE. MARIE TRIBAL HEALTH | Sault Ste. Marie Tribal Health | 2/22/2023 7:46 AM |
| Details | Entity Subname | Update | Change Request | MANISTIQUE TRIBAL HEALTH CENTER | Manistique Tribal Health Center | 2/22/2023 7:46 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2022 10:28:58 AM | 2/14/2023 4:40:05 PM | 2/14/2023 4:40 PM |
| Contacts | Authorizing Official | Update | New Registration | Lumsden, Joel P
Sault Tribe Health Division Assistant Director
Sault Ste. Marie Tribal Health
9066320611-46011 | Lumsden, Joel P
Sault Tribe Health Division Assistant Director
Sault Ste. Marie Tribal Health
9066320611-46011 | 10/11/2022 10:40 AM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2021 12:14:56 PM | 2/7/2022 10:28:58 AM | 2/7/2022 10:28 AM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1508957747 ( ) | | 2/4/2021 12:14 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1508957747 | 2/4/2021 12:14 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | MI | 2/4/2021 12:14 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2020 9:23:51 AM | 2/4/2021 12:14:56 PM | 2/4/2021 12:14 PM |
| Details | Last Recertification Date | Update | Recertification | 2/12/2019 10:29:14 AM | 1/29/2020 9:23:51 AM | 1/29/2020 9:23 AM |
| Details | Last Recertification Date | Update | Recertification | 2/15/2018 11:44:12 AM | 2/12/2019 10:29:14 AM | 2/12/2019 10:29 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2017 12:00:00 AM | 2/15/2018 11:44:12 AM | 2/15/2018 11:44 AM |
| Contacts | Authorizing Official | Update | | Lumsden, Joel
Sault Tribe Health Division Assistant Director
9066320611 | Lumsden, Joel P
Sault Tribe Health Division Assistant Director
Sault Ste. Marie Tribal Health
9066320611-46011 | 2/15/2018 11:35 AM |
| Contacts | Primary Contact | Update | | Meehan, Thomas D.
Chief Pharmacist
9066325226 | Meehan, Thomas D.
Chief Pharmacist
Sault Ste. Marie Tribal Health
9066325226 | 9/18/2017 3:00 PM |
| Contacts | Authorizing Official | Update | | MCPHERSON, CHRISTINE
ACTING HEALTH DIRECTOR
9066325250-25273 | Lumsden, Joel
Sault Tribe Health Division Assistant Director
9066320611 | 1/30/2017 12:15 PM |
| Contacts | Primary Contact | Insert | | | Meehan, Thomas D.
Chief Pharmacist
9066325226 | 1/30/2017 12:15 PM |
| Addresses | Main Address | Insert | | |
5698 W US-2
MANISTIQUE, MI 49854 | 1/30/2017 12:01 PM |
| Details | Last Recertification Date | Update | | 2/23/2016 12:00:00 AM | 1/30/2017 12:00:00 AM | 1/30/2017 12:01 PM |
| Addresses | Shipping Address | Insert | | | SAULT STE. MARIE TRIBAL HEALTH PHARMACY
5698 W US-2
MANISTIQUE, MI 49854 | 1/25/2017 7:35 AM |
| Details | Entity Subname | Update | | MANISTIQUE TRIBAL HEALTH CLINIC | MANISTIQUE TRIBAL HEALTH CENTER | 1/25/2017 7:35 AM |
| Medicaid Billing | Medicaid: Is Primary | Update | | True | False | 2/23/2016 9:17 AM |
| Details | Last Recertification Date | Update | | 2/10/2015 12:00:00 AM | 2/23/2016 12:00:00 AM | 2/23/2016 9:17 AM |
| Details | Last Recertification Date | Update | | 2/24/2014 12:00:00 AM | 2/10/2015 12:00:00 AM | 2/10/2015 12:02 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 2/24/2014 12:00:00 AM | 2/24/2014 4:04 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/12/2013 8:52 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1508957747 | 1/9/2012 9:27 AM |
| Details | Comments Public | Insert | | | NEW SITE 07/01/05
1/9/12 add new shipping address and new AO old AO Mcpherson and new Culfa JH and new NPI | 1/9/2012 9:27 AM |
| Dates | Participating Approval Date | Update | | 5/3/2005 7:21:53 AM | 5/3/2005 12:00:00 AM | 1/9/2012 9:25 AM |
| Details | Comments Public | Insert | | | NEW SITE 07/01/05
1/9/12 add new shipping address and new AO old AO Mcpherson and new Culfa JH | 1/9/2012 9:25 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | True | 7/1/2005 12:00 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 2367010 | 7/1/2005 12:00 AM |
| Medicaid Billing | Medicaid: State | Insert | | | MI | 7/1/2005 12:00 AM |
| Contacts | Authorizing Official | Insert | | | MCPHERSON, CHRISTINE
ACTING HEALTH DIRECTOR
9066325250-25273 | 7/1/2005 12:00 AM |
| Details | Last Recertification Date | Insert | | | | 7/1/2005 12:00 AM |
| Details | Grant Number | Insert | | | | 7/1/2005 12:00 AM |
| Details | 340B ID | Insert | | | FQHC638489 | 7/1/2005 12:00 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 7/1/2005 12:00 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 7/1/2005 12:00 AM |
| Details | Medicare Provider Number | Insert | | | | 7/1/2005 12:00 AM |
| Details | Entity Name | Insert | | | SAULT STE. MARIE TRIBAL HEALTH | 7/1/2005 12:00 AM |
| Details | Program Code | Insert | | | FQHC638 | 7/1/2005 12:00 AM |
| Details | Entity Subname | Insert | | | MANISTIQUE TRIBAL HEALTH CLINIC | 7/1/2005 12:00 AM |
| Dates | Participating Approval Date | Insert | | | 5/3/2005 7:21:53 AM | 7/1/2005 12:00 AM |
| Details | State | Insert | | | Active | 7/1/2005 12:00 AM |
| Dates | Registration Date | Insert | | | 7/1/2005 12:00:00 AM | 7/1/2005 12:00 AM |
| Dates | Signed By Date | Insert | | | 4/20/2005 12:00:00 AM | 7/1/2005 12:00 AM |
| Dates | Start Date | Insert | | | 7/1/2005 12:00:00 AM | 7/1/2005 12:00 AM |
| Terminations | Termination Comments | Insert | | | | 7/1/2005 12:00 AM |
| Terminations | Termination Date | Insert | | | | 7/1/2005 12:00 AM |
| Terminations | Termination Effective Date | Insert | | | | 7/1/2005 12:00 AM |
| Terminations | Termination Reason | Insert | | | | 7/1/2005 12:00 AM |
| Details | Comments Public | Insert | | | NEW SITE 07/01/05 | 7/1/2005 12:00 AM |