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DSH130007BM Saint Alphonsus Regional Medical Center (Terminated)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG McMillan Internal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007BM
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/15/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/28/2013
Last Recertification Date
9/3/2015
Termination Date
Termination Reason
4/1/2016
Site closure
Contacts
Authorizing Official
Saint Alphonsus Health System
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Primary Contact
Mark Phillips, Director of Pharmacy
(208) 367-4943
Addresses
Street Address
12273 W. McMillan Rd
Boise, ID 83713-0555
Billing Address
SAMG McMillan Internal Medicine
1055 N. Curtis Rd.
Boise, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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