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FQHC638160 Sault Ste. Marie Tribal Health (Active)
Main Details
Name
Sault Ste. Marie Tribal Health
Subdivision Name
Sault Ste. Marie Tribal Health Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638160
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
7/1/1997
Participating Start Date
7/1/1997
Participating Approval Date
4/26/2005
Last Recertification Date
2/22/2024
Addresses
Street Address
2864 Ashmun Street
Sault Ste. Marie, MI 49783
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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CHANGE CONTACT, EMAIL INFO, 4/26/05 - NEW MEDICAID # 1/9/12 add NPI, add shipping address, change AO from Meehan to Culfa JH
01/09/2012
CHANGE CONTACT, EMAIL INFO, 4/26/05 - NEW MEDICAID #
04/26/2005
May 2024
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