340B Drug Pricing Program Database


FQHC638024F UNITED INDIAN HEALTH SERVICES, INC. (Active) - information as of 4/29/2025 1:43:10 AM

Main Details
UNITED INDIAN HEALTH SERVICES, INC.
Eureka Lucas St
Tribal Contract/Compact with IHS (P.L. 93-638)
FQHC638024F


Additional Details
Active
4/9/2020
7/1/2020
4/28/2020
3/3/2025

Contacts

United Indian Health Services
Christopher Myers, Chief Clinical Officer
(707) 825-4070

United Indian Health Services
Kanako Miyamoto, Pharmacy Director
(707) 825-4095

Addresses

2505 Lucas St.
Suite A
Eureka, CA 95501

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
CATHP70960F1588660104,1982782256,1497751572
Shipping Addresses

Same as Street Address
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailGARFIELD BEACH CVS, L.L.C.CVS PHARMACY # 16759 2525 4TH ST
EUREKACA9550107/14/202110/01/2021  10/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY #10478 657 US HIGHWAY 101 N.
CRESCENT CITYCA9553107/14/202110/01/2021  10/01/2021
Contract DetailGARFIELD BEACH CVS, L.L.C.DBA CVS/PHARMACY # 10513 1720 CENTRAL AVE
MCKINLEYVILLECA9551907/14/202110/01/2021  10/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09681 1105 MYRTLE AVE
EUREKACA9550107/14/202110/01/2021  10/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09482 600 F ST
ARCATACA9552107/14/202110/01/2021  10/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 03939 800 W HARRIS ST STE 20
EUREKACA9550307/14/202110/01/2021  10/01/2021
Contract DetailLONGS DRUG STORES CALIFORNIA, L.L.C.DBA: CVS/PHARMACY # 09973 1595 MAIN STREET
WEAVERVILLECA9609307/14/202110/01/2021  10/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 04681 1424 BROADWAY STREET
EUREKACA9550110/18/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 05863 2525 HARRIS STREET
EUREKACA95503-480510/18/202301/01/2024  01/01/2024
Contract DetailWALGREEN CO.DBA: WALGREENS # 09703 1065 S FORTUNA BLVD
FORTUNACA9554010/18/202301/01/2024  01/01/2024
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification2/12/2024 10:48:19 AM3/3/2025 8:01:05 PM3/3/2025 8:01 PM
DetailsEntity SubnameUpdateChange RequestEureka Health CenterEureka Lucas St1/22/2025 12:33 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False6/25/2024 4:08 PM
Medicaid BillingMedicaid: NumberInsertChange Request THP70960F6/25/2024 4:08 PM
Medicaid BillingMedicaid: StateInsertChange Request CA6/25/2024 4:08 PM
Medicaid BillingNPI: NumberInsertChange Request 15886601046/25/2024 4:08 PM
Medicaid BillingNPI: StateInsertChange Request CA6/25/2024 4:08 PM
Medicaid BillingNPI: NumberInsertChange Request 19827822566/25/2024 4:08 PM
Medicaid BillingNPI: StateInsertChange Request CA6/25/2024 4:08 PM
Medicaid BillingNPI: NumberInsertChange Request 14977515726/25/2024 4:08 PM
Medicaid BillingNPI: StateInsertChange Request CA6/25/2024 4:08 PM
AddressesMain AddressUpdateChange Request 2332 Harrison Ave. Suite C&D EUREKA, CA 95501 2505 Lucas St. Suite A Eureka, CA 955013/20/2024 6:01 AM
DetailsLast Recertification DateUpdateRecertification2/5/2023 11:18:42 AM2/12/2024 10:48:19 AM2/12/2024 10:48 AM
DetailsLast Recertification DateUpdateRecertification2/21/2022 11:43:26 AM2/5/2023 11:18:42 AM2/5/2023 11:18 AM
DetailsLast Recertification DateUpdateRecertification2/24/2021 12:51:02 PM2/21/2022 11:43:26 AM2/21/2022 11:43 AM
ContactsPrimary ContactUpdateProfile Change RequestMiyamoto, Kanako Interim Pharmacy Director United Indian Health Services 7078254082Miyamoto, Kanako Pharmacy Director United Indian Health Services 70782540951/23/2022 8:58 PM
ContactsAuthorizing OfficialUpdateChange RequestRudd, Jedediah Chief Operating Officer United Indian Health Services 7078254049Myers, Christopher Chief Clinical Officer United Indian Health Services 707825407010/12/2021 8:23 AM
ContactsPrimary ContactUpdateChange RequestConnell, Timothy John Pharmacist In Charge United Indian Health Services, Inc. 7078254082Miyamoto, Kanako Interim Pharmacy Director United Indian Health Services 70782540829/15/2021 7:43 AM
ContactsPrimary ContactUpdateChange RequestConnell, Timothy John Pharmacy Director United Indian Health Services, Inc. 7078254082Connell, Timothy John Pharmacist In Charge United Indian Health Services, Inc. 70782540822/26/2021 11:03 AM
ContactsAuthorizing OfficialUpdateAO Change RequestRosen, David Abbot Chief Financial Officer United Indian Health Services 7078254065Rudd, Jedediah Chief Operating Officer United Indian Health Services 70782540492/26/2021 9:24 AM
DetailsLast Recertification DateUpdateRecertification 2/24/2021 12:51:02 PM2/24/2021 12:51 PM
DetailsStateUpdate ApprovedActive7/1/2020 12:00 AM
AddressesMain AddressInsertNew Registration  2332 Harrison Ave. Suite C&D EUREKA, CA 955014/28/2020 12:46 PM
ContactsSigned ByInsertNew Registration Rosen, David Abbot Chief Financial Officer United Indian Health Services 70782540654/28/2020 12:46 PM
Details340B IDUpdateNew Registration FQHC638024F4/28/2020 12:46 PM
DatesParticipating Approval DateUpdateNew Registration 4/28/2020 12:46:06 PM4/28/2020 12:46 PM
DetailsStateUpdateNew RegistrationPendingApproved4/28/2020 12:46 PM
DatesSigned By DateUpdateNew Registration 4/13/2020 4:36:56 PM4/28/2020 12:46 PM
DatesStart DateUpdateNew Registration 7/1/2020 12:00:00 AM4/28/2020 12:46 PM
AddressesMain AddressInsertNew Registration  1600 Weeot Way EUREKA, CA 955214/9/2020 12:45 PM
AddressesBilling AddressInsertNew Registration United Indian Health Services 1600 Weeot Way Arcata, CA 955214/9/2020 12:45 PM
ContactsPrimary ContactInsertNew Registration Connell, Timothy John Pharmacy Director United Indian Health Services, Inc. 70782540824/9/2020 12:45 PM
ContactsAuthorizing OfficialInsertNew Registration Rosen, David Abbot Chief Financial Officer United Indian Health Services 70782540654/9/2020 12:45 PM
DetailsLast Recertification DateInsertNew Registration  4/9/2020 12:45 PM
DetailsGrant NumberInsertNew Registration  4/9/2020 12:45 PM
Details340B IDInsertNew Registration  4/9/2020 12:45 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/9/2020 12:45 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/9/2020 12:45 PM
DetailsMedicare Provider NumberInsertNew Registration  4/9/2020 12:45 PM
DetailsEntity NameInsertNew Registration UNITED INDIAN HEALTH SERVICES, INC.4/9/2020 12:45 PM
DetailsProgram CodeInsertNew Registration FQHC6384/9/2020 12:45 PM
DetailsEntity SubnameInsertNew Registration Eureka Health Center4/9/2020 12:45 PM
DatesParticipating Approval DateInsertNew Registration  4/9/2020 12:45 PM
DetailsStateInsertNew Registration Pending4/9/2020 12:45 PM
DatesRegistration DateInsertNew Registration 4/9/2020 12:45:47 PM4/9/2020 12:45 PM
DatesSigned By DateInsertNew Registration  4/9/2020 12:45 PM
DatesStart DateInsertNew Registration  4/9/2020 12:45 PM
TerminationsTermination CommentsInsertNew Registration  4/9/2020 12:45 PM
TerminationsTermination DateInsertNew Registration  4/9/2020 12:45 PM
TerminationsTermination Effective DateInsertNew Registration  4/9/2020 12:45 PM
TerminationsTermination ReasonInsertNew Registration  4/9/2020 12:45 PM