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FQHC638487A SNOQUALMIE INDIAN TRIBE (Terminated)
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Main Details
Name
SNOQUALMIE INDIAN TRIBE
Subdivision Name
NORTH BEND FAMILY CLINIC
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638487A
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2005
Participating Start Date
7/1/2005
Participating Approval Date
6/9/2005
Last Recertification Date
2/23/2017
Termination Date
Termination Reason
4/1/2017
Failure to recertify
Contacts
Authorizing Official
Rebecca Crocker, Health & Wellness Officer
(425) 888-6551 Ext: 6226
Primary Contact
Rebecca Crocker, Health & Wellness Officer
(425) 888-6551 Ext: 6226
Addresses
Street Address
404 MAIN AVENUE S
NORTH BEND, WA 98045
Billing Address
SNOQUALMIE INDIAN TRIBE
P.O. BOX 969
SNOQUALMIE, WA 98065
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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10/3/08 UPDATED BILL TO (WAS PO BOX 28 CARNATION WA 98014); 09/19/08 UPDATED ADDR (WAS 406 MAIN AVENUE S)
01/12/2010
May 2025
May 2025
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