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DSH130007BS Saint Alphonsus Regional Medical Center (Active)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG Breast And Gen Surg Liberty
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007BS
Medicare Provider Number
130007
Outpatient Facility Provider Number
130007
Additional Details
Current Program Status
Active
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/3/2014
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
900 N Liberty St. Ste. 101
Boise, ID 83704
Billing Address
SAMG Breast And Gen Surg Liberty
1055 N. Curtis Rd.
Boise, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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