In 2017, the Indian Health Service (IHS) initiated a design-build procurement for its largest multi-tribal health clinic—a 200,000 SF outpatient facility in Rapid City, South Dakota. Over six years, the project team navigated the complexities of multi-tribal representation, federal procurement, and cultural integration to deliver a facility designed to advance patient safety, access, and community care. This session will share key lessons learned from the design and construction process, highlighting how design-build delivery influenced planning, coordination, and outcomes. Presenters from IHS and Bodwé Professional Services Group will discuss collaboration strategies, post-occupancy insights gathered from end users, and how project governance under Public Law 93-638 informed both process and results. Attendees will gain actionable takeaways on the advantages and limitations of design-build delivery for large-scale federal healthcare facilities, offering lessons applicable to projects of any scale or location. Core Competencies: Strategic Planning, Space Planning and Programming, Design, Transition Planning, Equipment Planning, Equipment Acquisition, Construction Management AIA Course Number: 2025.04.015 AIA LU/HSW = 1 LU