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DSH130013D SAINT ALPHONSUS MEDICAL CENTER-NAMPA (Terminated)
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Main Details
Name
SAINT ALPHONSUS MEDICAL CENTER-NAMPA
Subdivision Name
Saint Alphonsus Medical Center-Nampa Garrity Campus
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130013D
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
9/8/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Saint Alphonsus Health System
Lannie Checketts, RHM CFO Idaho Oregon Region
(208) 367-7347
Primary Contact
Barry Mallard, Director of Pharmacy Services
(208) 463-5365
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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