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DSH130007BZ Saint Alphonsus Regional Medical Center (Terminated)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG Orthopedics Dallan Woods / SAMG Orthopedics Dallan Woods
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007BZ
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2014
Participating Start Date
1/1/2015
Participating Approval Date
12/4/2014
Last Recertification Date
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Saint Alphonsus Health System
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Primary Contact
Mark Phillips, Director of Pharmacy
(208) 367-4943
Addresses
Street Address
214 S Midland Blvd
Nampa, ID 83686
Billing Address
SAMG Orthopedics Dallan Woods
1055 N. Curtis Rd.
Boise, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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