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FQHC638492B Cow Creek Band of Umpqua Tribe of Indians (Terminated)
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Main Details
Name
Cow Creek Band of Umpqua Tribe of Indians
Subdivision Name
Cow Creek Health & Wellness Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638492B
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/15/2013
Last Recertification Date
2/26/2018
Termination Date
Termination Reason
4/1/2019
Failure to recertify
Contacts
Authorizing Official
Cow Creek Band of Umpqua Tribe of Indians
Sharon Arlene Stanphill, Health Operations Officer
(541) 672-8533 Ext: 5517
Primary Contact
Cow Creek Health & Wellness Center
Mary Stevenson, Health Business Operations Administration
(541) 672-8533 Ext: 5200
Addresses
Street Address
480 Wartahoo Lane
Canyonville, OR 97417
Billing Address
Cow Creek Health & Wellness Center
2371 NE Stephens
Suite 200
Roseburg, OR 97470
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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