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FQHC638541 Blackfeet Tribe (Terminated)
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Main Details
Name
Blackfeet Tribe
Subdivision Name
Southern Piegan Diabetes Progran
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638541
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/6/2019
Last Recertification Date
Termination Date
Termination Reason
4/1/2020
Failure to recertify
Contacts
Authorizing Official
Southern Peigan Health Center
Roberta Wagner, Administrator
(406) 338-7912
Primary Contact
Southern Peigan Health Center
Arnold Scott Devous, Medical Doctor
(801) 554-1775
Addresses
Street Address
503 Popimi Street
Browning, MT 59417-0850
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date (04/01/2016) until terminated effective date (04/01/2018), reinstatement effective date (04/01/2019)
02/06/2019
May 2025
May 2025
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