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DSH130007Q Saint Alphonsus Regional Medical Center (Active)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG EHP Internal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007Q
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/28/2013
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
323 Riverside Drive Ste. 224
Eagle, ID 83616-4959
Billing Address
SAMG EHP Internal Medicine
1055 N. Curtis Rd.
Boise, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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