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FQHC638543 Northern Cheyenne Tribe (Terminated)
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Main Details
Name
Northern Cheyenne Tribe
Subdivision Name
Northern Cheyenne Tribal Health
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638543
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/3/2016
Last Recertification Date
2/23/2017
Termination Date
Termination Reason
4/1/2017
Failure to recertify
Contacts
Authorizing Official
Tammy Roundstone, Diabetes Coordinator
(406) 477-4941
Primary Contact
Tammy Roundstone, Diabetes Coordinator
(406) 477-4941
Addresses
Street Address
600 cheyenne avenue south
box 67
Lame Deer, MT 59043
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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June 2025
June 2025
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