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FQHC638009 LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC (Active)
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Main Details
Name
LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC
Subdivision Name
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638009
Additional Details
Current Program Status
Active
Registration Date
1/1/1995
Participating Start Date
1/1/1995
Participating Approval Date
1/11/2011
Last Recertification Date
2/10/2025
Contacts
Authorizing Official
LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC
Dr. Andre Pierre Lallande, Chief Medical Officer
(707) 533-7781
Primary Contact
Lake County Tribal Health
Kevin Lee Thompson, Southshore Clinic Manager/Compliance Officer
(707) 263-8382 Ext: 1218
Addresses
Street Address
925 BEVINS COURT
LAKEPORT, CA 95453
Billing Address
LAKE COUNTY TRIBAL HEALTH CONSORTIUM, INC
P.O. BOX 1950
LAKEPORT, CA 95453
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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June 2025
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