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FQHC638610 Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians (Active)
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Main Details
Name
Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians
Subdivision Name
Three Rivers Health Center
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638610
Additional Details
Current Program Status
Active
Registration Date
10/5/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/25/2023
Last Recertification Date
2/12/2025
Contacts
Authorizing Official
Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians
Lee Ann Wander, CEO
(541) 888-7527
Primary Contact
Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians
Donald Lee Moos, Compliance Officer
(541) 435-7172
Addresses
Street Address
150 S Wall St
Coos Bay, OR 97420
Billing Address
Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians
1245 Fulton Ave
Coos County, OR 97420
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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