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DSH130007EZ Saint Alphonsus Regional Medical Center (Active)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG Heart Failure Moreau - Cardiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007EZ
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/19/2024
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Saint Alphonsus Health System
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Primary Contact
Trinity Health
Carisa Ann McGehee, 340B Analyst
(208) 367-2087
Addresses
Street Address
6140 W Curtisian Ave
102
Boise, ID 83704
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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