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FQHC638532 Coquille Indian Tribe (Active)
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Main Details
Name
Coquille Indian Tribe
Subdivision Name
Ko-Kwel Wellness Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638532
Additional Details
Current Program Status
Active
Registration Date
4/11/2016
Participating Start Date
7/1/2016
Participating Approval Date
6/2/2016
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
Coquille Indian Tribe
Kelle Little, Health and Human Services Administrator
(541) 888-9494 Ext: 2217
Primary Contact
Coquille Indian Tribe
Caryn Mickelson, Pharmacy Director
(541) 888-9494
Addresses
Street Address
630 Miluk Drive
Coos Bay, OR 97420
Billing Address
CIT Retail Pharmacy 340B
600 Miluk Drive
Coos Bay, OR 97420
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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6/2/16 Previously participated 7/1/13 until terminated 4/1/16, reinstatement effective 7/1/16;
06/02/2016
April 2025
April 2025
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