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FQHC638292A GILA RIVER HEALTH CARE CORPORATION (Active)
Main Details
Name
GILA RIVER HEALTH CARE CORPORATION
Subdivision Name
KOMATKE HEALTH CENTER
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638292A
Contacts
Authorizing Official
Gila River Health Care
Judith Roth, CFO
(602) 528-1172
Primary Contact
Gila River Health Care
MEENA BHARGAVA, PHARMACY DIRECTOR
(602) 528-1200 Ext: 1115
Additional Details
Current Program Status
Active
Registration Date
9/13/2007
Participating Start Date
10/1/2007
Participating Approval Date
9/14/2007
Last Recertification Date
2/4/2024
Addresses
Street Address
17487 S HEALTH CARE DRIVE
LAVEEN, AZ 85339
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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10/9/09 UPDATED SUBDIV NAME;10/9/09 UPDATED ADDR (WAS GILA CROSSING CLINIC AT 9743 W PECOS ROAD)
01/13/2010
May 2024
May 2024
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