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FQHC638013 PIT RIVER HEALTH SERVICES (Active)
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Main Details
Name
PIT RIVER HEALTH SERVICES
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638013
Additional Details
Current Program Status
Active
Registration Date
1/1/1995
Participating Start Date
7/1/2014
Participating Approval Date
11/3/2009
Last Recertification Date
2/11/2025
Contacts
Authorizing Official
PIT RIVER HEALTH SERVICE, INC
Sophia Rae Villarruel, Interim Authorizing Official
(530) 335-0332
Primary Contact
Pit River Health Service
Jeremy Wheeler, CFO
(530) 335-5090 Ext: 133
Addresses
Street Address
36977 PARK AVE.
BURNEY, CA 96013
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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6/3/14 enrolled 1/1/95 thru 3/31/14, not enrolled 4/1/14 thru 6/30/14 due to failure to recertify, re-instated based on on-line registration submitted in Apr. 2014; 11/03/09 UPDATED ADDR(WAS PO BOX 279.)
06/03/2014
11/03/09 UPDATED ADDR(WAS PO BOX 279.)
01/13/2010
April 2025
April 2025
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