340B Drug Pricing Program Database
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DSH130007BW Saint Alphonsus Regional Medical Center (Terminated)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG Behavioral Health
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007BW
Medicare Provider Number
130007
Outpatient Facility Provider Number
130007
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/3/2014
Last Recertification Date
9/13/2021
Termination Date
Termination Reason
7/1/2022
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
131 N. Allumbaugh
Boise, ID 83704
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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