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FQHC638492 COW CREEK BAND OF UMPQUA TRIBE OF INDIANS (Active)
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Main Details
Name
COW CREEK BAND OF UMPQUA TRIBE OF INDIANS
Subdivision Name
COW CREEK HEALTH AND WELLNESS CENTER
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638492
Additional Details
Current Program Status
Active
Registration Date
4/4/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/1/2019
Last Recertification Date
2/26/2025
Contacts
Authorizing Official
Cow Creek Band of Umpqua Tribe of Indians
Allyson Kristine Nicolas, Health Operations Officer
(541) 900-9215
Primary Contact
Cow Creek Health & Wellness Center
Tamara Ann Robinson, Clinic Operations Coordinator
(541) 691-2433
Addresses
Street Address
2589 NW Edenbower Blvd
ROSEBURG, OR 97471-6220
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date (10/1/2009), until terminated effective date (4/1/2019), reinstatement effective date (07/01/2019)
05/01/2019
April 2025
April 2025
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