| Details | Last Recertification Date | Update | Recertification | 2/1/2024 4:17:01 PM | 2/12/2025 8:13:33 PM | 2/12/2025 8:13 PM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2023 11:13:23 AM | 2/1/2024 4:17:01 PM | 2/1/2024 4:17 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | lapointe, jennifer
health administrator
Swinomish Medical Clinic
3604661945 | LaPointe, Jennifer
General Manager
Swinomish Medical Clinic
3604663167 | 7/13/2023 7:17 AM |
| Contacts | Signed By | Update | Profile Change Request | lapointe, jennifer
health administrator
Swinomish Medical Clinic
3604661945 | LaPointe, Jennifer
General Manager
Swinomish Medical Clinic
3604663167 | 7/13/2023 7:17 AM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2022 8:32:20 AM | 2/7/2023 11:13:23 AM | 2/7/2023 11:13 AM |
| Contacts | Primary Contact | Update | Recertification | bowen, quintina
medical office manager
swinomish health clinic
3604667277 | Perry, Michelle
Office Manager
Swinomish Health Clinic
3604663167 | 2/17/2022 8:32 AM |
| Details | Last Recertification Date | Update | Recertification | | 2/17/2022 8:32:20 AM | 2/17/2022 8:32 AM |
| Details | State | Update | OPA Edit | Approved | Active | 4/7/2021 9:13 AM |
| Dates | Start Date | Update | OPA Edit | 7/1/2021 12:00:00 AM | 4/7/2021 12:00:00 AM | 4/7/2021 9:13 AM |
| Details | Comments Public | Insert | OPA Edit | | Participating from effective date: (4/1/2001), until terminated effective date: (04/01/2021) reinstatement effective date: (04/07/2021). | 4/7/2021 9:13 AM |
| Addresses | Main Address | Insert | Reinstatement | |
17400 RESERVATION ROAD
LA CONNER, WA 98257 | 4/7/2021 9:11 AM |
| Contacts | Authorizing Official | Update | Reinstatement | Rasar, Cheryl
Medical Director
Swinomish Indian Tribal Community
3604663167-7268 | lapointe, jennifer
health administrator
Swinomish Medical Clinic
3604661945 | 4/7/2021 9:11 AM |
| Contacts | Signed By | Insert | Reinstatement | | lapointe, jennifer
health administrator
Swinomish Medical Clinic
3604661945 | 4/7/2021 9:11 AM |
| Details | Last Recertification Date | Update | Reinstatement | 2/11/2020 3:34:32 PM | | 4/7/2021 9:11 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 3/31/2021 12:00:00 AM | | 4/7/2021 9:11 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 4/1/2001 12:00:00 AM | 4/7/2021 9:11:06 AM | 4/7/2021 9:11 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 4/7/2021 9:11 AM |
| Dates | Registration Date | Update | Reinstatement | 4/1/2001 12:00:00 AM | 4/1/2021 3:29:45 PM | 4/7/2021 9:11 AM |
| Dates | Signed By Date | Update | Reinstatement | | 4/1/2021 3:45:42 PM | 4/7/2021 9:11 AM |
| Dates | Start Date | Update | Reinstatement | 4/1/2001 12:00:00 AM | 7/1/2021 12:00:00 AM | 4/7/2021 9:11 AM |
| Terminations | Termination Date | Update | Reinstatement | 4/1/2021 12:00:00 AM | | 4/7/2021 9:11 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 3/31/2021 12:00:00 AM | | 4/7/2021 9:11 AM |
| Terminations | Termination Reason | Update | Reinstatement | Failure to recertify | | 4/7/2021 9:11 AM |
| Details | State | Update | | To Be Terminated | Terminated | 4/1/2021 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 3/31/2021 12:00:00 AM | 3/10/2021 12:15 PM |
| Details | State | Update | Recertification | Active | To Be Terminated | 3/10/2021 12:15 PM |
| Terminations | Termination Date | Update | Recertification | | 4/1/2021 12:00:00 AM | 3/10/2021 12:15 PM |
| Terminations | Termination Effective Date | Update | Recertification | | 3/31/2021 12:00:00 AM | 3/10/2021 12:15 PM |
| Terminations | Termination Reason | Update | Recertification | | Failure to recertify | 3/10/2021 12:15 PM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2019 9:01:23 PM | 2/11/2020 3:34:32 PM | 2/11/2020 3:34 PM |
| Contacts | Primary Contact | Update | Recertification | White, Shyra
HEALTH BILLER
Swinomish Indian Tribal Community
3605882737 | bowen, quintina
medical office manager
swinomish health clinic
3604667277 | 1/30/2019 9:01 PM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2018 3:18:15 PM | 1/30/2019 9:01:23 PM | 1/30/2019 9:01 PM |
| Contacts | Primary Contact | Update | Recertification | Martin, Jennifer
HEALTH BILLER
3605882734 | White, Shyra
HEALTH BILLER
Swinomish Indian Tribal Community
3605882737 | 2/13/2018 3:18 PM |
| Details | Last Recertification Date | Update | Recertification | 2/13/2017 12:00:00 AM | 2/13/2018 3:18:15 PM | 2/13/2018 3:18 PM |
| Addresses | Shipping Address | Insert | Change Request | | Swinomish Health Clinics - didgwalic
8212 South March Point Road
Anacortes, WA 98221 | 11/7/2017 10:59 AM |
| Addresses | Shipping Address | Insert | Change Request | | Swinomish Indian Tribal Community Health Clinics
17400 Reservation Road
LACONNER, WA 98257 | 11/7/2017 10:59 AM |
| Contacts | Authorizing Official | Update | | Rasar, Cheryl
Medical Director
3604663167-7268 | Rasar, Cheryl
Medical Director
Swinomish Indian Tribal Community
3604663167-7268 | 10/16/2017 11:20 AM |
| Addresses | Main Address | Insert | | |
17400 RESERVATION ROAD
LA CONNER, WA 98257 | 7/3/2017 4:47 PM |
| Contacts | Primary Contact | Update | | Martin, Jennifer
HEALTH BILLER
3605882734 | Martin, Jennifer
HEALTH BILLER
3605882734 | 7/3/2017 4:47 PM |
| Contacts | Authorizing Official | Update | | CLADOOSBY, BRIAM M.
CHAIRMAN
3604663167 | Rasar, Cheryl
Medical Director
3604663167-7268 | 7/3/2017 4:47 PM |
| Contacts | Primary Contact | Update | | CLADOOSBY, BRIAM M.
CHAIRMAN
3604663167 | Martin, Jennifer
HEALTH BILLER
3605882734 | 2/13/2017 1:50 PM |
| Details | Last Recertification Date | Update | | 2/16/2016 12:00:00 AM | 2/13/2017 12:00:00 AM | 2/13/2017 1:50 PM |
| Details | Last Recertification Date | Update | | 1/29/2015 12:00:00 AM | 2/16/2016 12:00:00 AM | 2/16/2016 2:29 PM |
| Details | Last Recertification Date | Update | | 3/5/2014 12:00:00 AM | 1/29/2015 12:00:00 AM | 1/29/2015 3:42 PM |
| Details | Entity Subname | Update | | | Swinomish Health Clinics | 1/29/2015 3:42 PM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/5/2014 12:00:00 AM | 3/5/2014 1:22 PM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 2/12/2013 8:53 AM |
| Contacts | Authorizing Official | Insert | | | CLADOOSBY, BRIAM M.
CHAIRMAN
3604663167 | 1/22/2013 11:13 AM |
| Contacts | Primary Contact | Insert | | | CLADOOSBY, BRIAM M.
CHAIRMAN
3604663167 | 1/22/2013 11:13 AM |
| Details | Last Recertification Date | Insert | | | | 9/8/2006 12:52 PM |
| Details | Grant Number | Insert | | | | 9/8/2006 12:52 PM |
| Details | 340B ID | Insert | | | FQHC638347 | 9/8/2006 12:52 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 9/8/2006 12:52 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 9/8/2006 12:52 PM |
| Details | Medicare Provider Number | Insert | | | | 9/8/2006 12:52 PM |
| Details | Entity Name | Insert | | | SWINOMISH INDIAN TRIBAL COMM | 9/8/2006 12:52 PM |
| Details | Program Code | Insert | | | FQHC638 | 9/8/2006 12:52 PM |
| Details | Entity Subname | Insert | | | | 9/8/2006 12:52 PM |
| Dates | Participating Approval Date | Insert | | | 4/1/2001 12:00:00 AM | 9/8/2006 12:52 PM |
| Details | State | Insert | | | Active | 9/8/2006 12:52 PM |
| Dates | Registration Date | Insert | | | 4/1/2001 12:00:00 AM | 9/8/2006 12:52 PM |
| Dates | Signed By Date | Insert | | | | 9/8/2006 12:52 PM |
| Dates | Start Date | Insert | | | 4/1/2001 12:00:00 AM | 9/8/2006 12:52 PM |
| Terminations | Termination Comments | Insert | | | | 9/8/2006 12:52 PM |
| Terminations | Termination Date | Insert | | | | 9/8/2006 12:52 PM |
| Terminations | Termination Effective Date | Insert | | | | 9/8/2006 12:52 PM |
| Terminations | Termination Reason | Insert | | | | 9/8/2006 12:52 PM |