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FQHC638483 MACT Health Board, Inc. (Active)
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Main Details
Name
MACT Health Board, Inc.
Subdivision Name
MACT Medical, Jackson
Type
Tribal Contract/Compact with IHS (P.L. 93-638)
340B ID
FQHC638483
Additional Details
Current Program Status
Active
Registration Date
1/1/2003
Participating Start Date
1/1/2003
Participating Approval Date
6/3/2009
Last Recertification Date
2/18/2025
Contacts
Authorizing Official
MACT Health Board, Inc
John Shawver Alexander, Executive Director
(209) 754-6258
Primary Contact
MACT Health Board, Inc.
Mariela Contreras, Finance Director
(209) 754-6245
Addresses
Street Address
12140 NEW YORK RANCH ROAD
JACKSON, CA 95642
Billing Address
MACT Health Board, Inc.
PO BOX 939
ANGELS CAMP, CA 95222
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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9/16/09 ADDED BILLING ADDR; 8/8/06 - NEW ADDR (WAS 15505 DALTONS DRIVE)
02/27/2014
9/16/09 ADDED BILLING ADDR; 8/8/06 - NEW ADDR (WAS 15505 DALTONS DRIVE)
06/03/2009
9/16/09 ADDED BILLING ADDR; 8/8/06 - NEW ADDR (WAS 15505 DALTONS DRIVE)
06/03/2009
April 2025
April 2025
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