| Details | Last Recertification Date | Update | Recertification | 2/2/2024 6:25:31 PM | 2/21/2025 11:45:31 AM | 2/21/2025 11:45 AM |
| Contacts | Authorizing Official | Update | Change Request | Pete, Preston
Finance Director
Santa Ynez Tribal Health Clinic
8056942640 | Finney, Courtney
Financial Services Manager
Santa Ynez Tribal Health Clinic
8052911241 | 2/7/2025 9:46 AM |
| Addresses | Billing Address | Update | Recertification | SANTA YNEZ TRIBAL HEALTH- DENTAL DEPARTMENT
680 Alamo Pintado Rd #202
Solvang, CA 93463 | SANTA YNEZ TRIBAL HEALTH- DENTAL DEPARTMENT
585 McMurray Rd
Attn: Cynthia Lara
Buellton, CA 93427 | 2/2/2024 6:25 PM |
| Details | Last Recertification Date | Update | Recertification | 2/16/2023 2:08:18 PM | 2/2/2024 6:25:31 PM | 2/2/2024 6:25 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Lara, Cynthia
Accountant I
Santa Ynez Tribal Health Clinic
8056942655 | Lara, Cynthia
Accountant I
Santa Ynez Tribal Health Clinic
8056911231 | 2/2/2024 12:48 PM |
| Details | Last Recertification Date | Update | Recertification | 3/3/2022 7:02:28 AM | 2/16/2023 2:08:18 PM | 2/16/2023 2:08 PM |
| Contacts | Primary Contact | Update | Change Request | Patterson, Jeremy
Accountant I
Santa Ynez Tribal Health Clinic
8056942613 | Lara, Cynthia
Accountant I
Santa Ynez Tribal Health Clinic
8056942655 | 8/31/2022 12:00 PM |
| Addresses | Billing Address | Update | Recertification | SANTA YNEZ TRIBAL HEALTH- DENTAL DEPARTMENT
P.O. BOX 539
SANTA YNEZ, CA 93460 | SANTA YNEZ TRIBAL HEALTH- DENTAL DEPARTMENT
680 Alamo Pintado Rd #202
Solvang, CA 93463 | 3/3/2022 7:02 AM |
| Details | Last Recertification Date | Update | Recertification | 2/11/2021 2:58:38 PM | 3/3/2022 7:02:28 AM | 3/3/2022 7:02 AM |
| Contacts | Authorizing Official | Update | OPA Edit | Sisson, Ron
EXECUTIVE DIRECTOR
Santa Ynez Tribal Health Clinic
8056942650-16 | Pete, Preston
Finance Director
Santa Ynez Tribal Health Clinic
8056942640 | 3/2/2022 9:25 AM |
| Contacts | Primary Contact | Update | OPA Edit | Pete, Preston
Finance Director
Santa Ynez Tribal Health Clinic
8056942640 | Patterson, Jeremy
Accountant I
Santa Ynez Tribal Health Clinic
8056942613 | 3/2/2022 9:25 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2020 11:46:17 AM | 2/11/2021 2:58:38 PM | 2/11/2021 2:58 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2019 12:23:49 PM | 1/28/2020 11:46:17 AM | 1/28/2020 11:46 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2018 2:55:52 PM | 1/29/2019 12:23:49 PM | 1/29/2019 12:23 PM |
| Contacts | Primary Contact | Update | Recertification | Lodes, Tami
Tribal Financial Officer
8256887997 | Pete, Preston
Finance Director
Santa Ynez Tribal Health Clinic
8056942640 | 2/8/2018 2:55 PM |
| Details | Last Recertification Date | Update | Recertification | 2/22/2017 12:00:00 AM | 2/8/2018 2:55:52 PM | 2/8/2018 2:55 PM |
| Contacts | Authorizing Official | Update | | Sisson, Ron
EXECUTIVE DIRECTOR
8056942650-16 | Sisson, Ron
EXECUTIVE DIRECTOR
Santa Ynez Tribal Health Clinic
8056942650-16 | 2/8/2018 2:44 PM |
| Addresses | Main Address | Insert | | |
90 VIA JUANA LANE
SANTA YNEZ, CA 93460 | 2/22/2017 7:41 PM |
| Contacts | Authorizing Official | Update | | MONTOYA, JESS
EXECUTIVE DIRECTOR
8056887070-16 | Sisson, Ron
EXECUTIVE DIRECTOR
8056942650-16 | 2/22/2017 7:41 PM |
| Contacts | Primary Contact | Update | | JASSO, JENNIFER
Admin. Svs Director
8056942640-18 | Lodes, Tami
Tribal Financial Officer
8256887997 | 2/22/2017 7:41 PM |
| Details | Last Recertification Date | Update | | 2/22/2016 12:00:00 AM | 2/22/2017 12:00:00 AM | 2/22/2017 7:41 PM |
| Details | Last Recertification Date | Update | | 1/30/2015 12:00:00 AM | 2/22/2016 12:00:00 AM | 2/22/2016 6:31 PM |
| Contacts | Primary Contact | Update | | JASSO, JENNIFER
FINANCIAL SVS. MANAGER
8056887070-18 | JASSO, JENNIFER
Admin. Svs Director
8056942640-18 | 1/30/2015 4:16 PM |
| Details | Last Recertification Date | Update | | 2/10/2014 12:00:00 AM | 1/30/2015 12:00:00 AM | 1/30/2015 4:16 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 2/10/2014 12:00:00 AM | 2/10/2014 12:34 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/26/2013 7:27 AM |
| Addresses | Billing Address | Insert | | | SANTA YNEZ TRIBAL HEALTH- DENTAL DEPARTMENT
P.O. BOX 539
SANTA YNEZ, CA 93460 | 6/3/2008 1:01 PM |
| Contacts | Primary Contact | Insert | | | JASSO, JENNIFER
FINANCIAL SVS. MANAGER
8056887070-18 | 6/3/2008 1:01 PM |
| Contacts | Authorizing Official | Insert | | | MONTOYA, JESS
EXECUTIVE DIRECTOR
8056887070-16 | 6/3/2008 1:01 PM |
| Details | Last Recertification Date | Insert | | | | 6/3/2008 1:01 PM |
| Details | Grant Number | Insert | | | | 6/3/2008 1:01 PM |
| Details | 340B ID | Insert | | | FQHC638444 | 6/3/2008 1:01 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 6/3/2008 1:01 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 6/3/2008 1:01 PM |
| Details | Medicare Provider Number | Insert | | | | 6/3/2008 1:01 PM |
| Details | Entity Name | Insert | | | SANTA YNEZ TRIBAL HEALTH | 6/3/2008 1:01 PM |
| Details | Program Code | Insert | | | FQHC638 | 6/3/2008 1:01 PM |
| Details | Entity Subname | Insert | | | DENTAL DEPARTMENT | 6/3/2008 1:01 PM |
| Dates | Participating Approval Date | Insert | | | 6/3/2008 12:00:00 AM | 6/3/2008 1:01 PM |
| Details | State | Insert | | | Active | 6/3/2008 1:01 PM |
| Dates | Registration Date | Insert | | | 6/2/2008 12:00:00 AM | 6/3/2008 1:01 PM |
| Dates | Signed By Date | Insert | | | 4/29/2008 12:00:00 AM | 6/3/2008 1:01 PM |
| Dates | Start Date | Insert | | | 7/1/2008 12:00:00 AM | 6/3/2008 1:01 PM |
| Terminations | Termination Comments | Insert | | | | 6/3/2008 1:01 PM |
| Terminations | Termination Date | Insert | | | | 6/3/2008 1:01 PM |
| Terminations | Termination Effective Date | Insert | | | | 6/3/2008 1:01 PM |
| Terminations | Termination Reason | Insert | | | | 6/3/2008 1:01 PM |