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FQHC638341 CAMAS CENTER FOR COMMUNITY WELLNESS MEDICAL SERVICES DEPARTMENT (Active)
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Main Details
Name
CAMAS CENTER FOR COMMUNITY WELLNESS MEDICAL SERVICES DEPARTMENT
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638341
Additional Details
Current Program Status
Active
Registration Date
5/4/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/8/2018
Last Recertification Date
2/19/2025
Contacts
Authorizing Official
Camas Center for Community Wellness
Jennifer Tackitt, ARNP
(509) 447-7111
Primary Contact
Camas Health
Rebekka Susso, Executive Assistant
(509) 789-7614
Addresses
Street Address
1821 LECLERC RD. #1
CUSICK, WA 99119
Billing Address
CAMAS CENTER FOR COMMUNITY WELLNESS MEDICAL SERVICES DEPARTMENT
P.O. BOX 67
USK, WA 99180
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date (4/1/2008) until terminated effective date (4/1/2018), reinstatement date effective date (07/01/2018)
04/13/2018
12/14/11 update Adress, Ao, PC JH
12/14/2011
April 2025
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