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DSH130007CQ Saint Alphonsus Regional Medical Center (Terminated)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG Comp Breast Surgery Nampa
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007CQ
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/13/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/11/2015
Last Recertification Date
8/30/2018
Termination Date
Termination Reason
10/1/2019
Site closure
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
4400 E Flamingo
Nampa, ID 83687
Billing Address
SAMG Comp Breast Surgery Nampa
1055 N. Curtis Rd.
Boise, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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