Pit River Health Service, Inc. (PRHS) is a tribal non-profit 501c3 corporation dedicated to delivering an array of healthcare services to the Pit River Tribe of northeast California (CA). In addition to serving the federally recognized Pit River Tribe, PRHS serves the general native and non-native public in our region. PRHS provides primary health care to rural residents in Lassen, Modoc and Shasta counties of CA. The three counties total 12,770 square miles, creating a vast and sparsely populated area in northeast CA. PRHS operates three sites: two in Alturas, California (Modoc County) and one in Burney, California (Shasta County).PRHS currently operates under a Title 1 PL 93-638 Indian Self Determination Act subcontract under the primary contract held by the California Rural Indian Health Board, Inc. Over the past several years PRHS has undertaken a concerted strategic development effort to increase its organizational capacity for independent administration of a high-quality healthcare program. Our proposed project outlines the steps required to move from a Title 1 contract to a Title V compact. New PFSAs will provide for greater patient satisfaction due to having on site services. Additionally, expansion of services will bring in additional revenue to provide future services. Moving from Title 1 contact to Title V compact will increase PRHS 638 funding, provide federal tort for our expanded services, and provide greater flexibility and control over programs that we currently have as a Title 1.PRHS is ready to move toward compacting more PFSAs at every level to improve resources and obtain greater flexibility in making program improvements, without seeking outside approvals by Area or CRIHB. Staff will be able to independently redesign programs and have less reporting. PRHS has demonstrated exceptional operations over the past years in financial, human resource, management, and clinical systems.