340B Drug Pricing Program Database
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DSH130007AL Saint Alphonsus Regional Medical Center (Terminated)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG Maternal Fetal Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007AL
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
8/24/2023
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
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
900 N. Liberty Ste. 206
Boise, ID 83706-8707
Billing Address
SAMG Maternal Fetal Medicine
1055 N. Curtis Rd.
Boise, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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