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FQHC638420 Sault Ste. Marie Tribal Health (Active)
Main Details
Name
Sault Ste. Marie Tribal Health
Subdivision Name
St. Ignace Tribal Health Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638420
Contacts
Authorizing Official
Sault Ste. Marie Tribal Health
Joel P Lumsden, Sault Tribe Health Division Assistant Director
(906) 632-0611 Ext: 46011
Primary Contact
Sault Ste. Marie Tribal Health
Danielle Goudreau, Chief Pharmacist
(906) 341-6993
Additional Details
Current Program Status
Active
Registration Date
1/1/1999
Participating Start Date
1/1/1999
Participating Approval Date
5/2/2005
Last Recertification Date
2/22/2024
Addresses
Street Address
1140 N. State St.
Suite 2805
St. Ignace, MI 49781
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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CHANGED CONTACT, E-MAIL, 4/26/05 - NEW MEDICAID # 1/9/12 update main address and AO from Meehan to Culfa add NPI JH
01/09/2012
CHANGED CONTACT, E-MAIL, 4/26/05 - NEW MEDICAID # 1/9/12 update main address and AO from Meehan to Culfa
01/09/2012
CHANGED CONTACT, E-MAIL, 4/26/05 - NEW MEDICAID #
05/02/2005
May 2024
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