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FQHC638489 Sault Ste. Marie Tribal Health (Active)
Main Details
Name
Sault Ste. Marie Tribal Health
Subdivision Name
Manistique Tribal Health Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638489
Contacts
Authorizing Official
Sault Ste. Marie Tribal Health
Joel P Lumsden, Sault Tribe Health Division Assistant Director
(906) 632-0611 Ext: 46011
Primary Contact
Sault Ste. Marie Tribal Health
Danielle Goudreau, Chief Pharmacist
(906) 341-6993
Additional Details
Current Program Status
Active
Registration Date
7/1/2005
Participating Start Date
7/1/2005
Participating Approval Date
5/3/2005
Last Recertification Date
2/26/2024
Addresses
Street Address
5698W US Highway 2
Manistique, MI 49854
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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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
01/09/2012
NEW SITE 07/01/05 1/9/12 add new shipping address and new AO old AO Mcpherson and new Culfa JH
01/09/2012
NEW SITE 07/01/05
07/01/2005
May 2024
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