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DSH130007W Saint Alphonsus Regional Medical Center (Active)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG BOISE PEDIATRICS MULVANEY
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007W
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2013
Participating Start Date
4/1/2015
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
1072 N LIBERTY STREET
SUITE 203
Boise, ID 83704-8708
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/13/15 participating 4/1/2013 thru 9/30/14, not participating 10/1/14 thru 3/31/15, reinstated effective 4/1/15 based on on-line registrations submitted in Jan. 2015
03/13/2015
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