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FQHC638337A TULALIP TRIBES (Active)
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Main Details
Name
TULALIP TRIBES
Subdivision Name
TULALIP HEALTH CLINIC
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638337A
Additional Details
Current Program Status
Active
Registration Date
4/1/2020
Participating Start Date
4/2/2020
Participating Approval Date
4/2/2020
Last Recertification Date
2/14/2025
Contacts
Authorizing Official
TULALIP HEALTH SYSTEM
Gary Ferguson, Interim Health System Administrator
(360) 716-4511
Primary Contact
Tulalip Clinical Pharmacy
Kelvin Lee, Manager
(360) 716-2660
Addresses
Street Address
7520 Totem Beach Road
Tulalip, WA 98271
Billing Address
TULALIP CLINIC FINANCE
7520 TOTEM BEACH ROAD
TULALIP, WA 98271
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date: (7/1/1998), until terminated effective date: (4/1/2020), reinstatement effective date: (07/01/2020).
04/02/2020
4/10/09 UPDATED ENTITY NAME AND ADDED BILL TO ADDR; 5/1/07 - IN-HOUSE PHARMACY CLOSED, BEGAN CONTRACT PHARMACY ARRANGEMENT
04/10/2009
April 2025
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