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DSH130013B SAINT ALPHONSUS MEDICAL CENTER-NAMPA (Terminated)
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Main Details
Name
SAINT ALPHONSUS MEDICAL CENTER-NAMPA
Subdivision Name
Nampa Emergency NHP
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130013B
Medicare Provider Number
130013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
8/17/2016
Termination Date
Termination Reason
10/1/2017
Site closure
Contacts
Authorizing Official
Saint Alphonsus Health System
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Primary Contact
Saint Alphonsus Health System
Mark Phillips, AVP Prof Services/Director SAHS Pharmacy
(208) 367-4943
Addresses
Street Address
4402 E FLAMINGO AVE
NAMPA, ID 83687-9203
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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