340B Drug Pricing Program Database
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DSH130007DL Saint Alphonsus Regional Medical Center (Terminated)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG W Chinden Urgent Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007DL
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/19/2016
Last Recertification Date
9/2/2020
Termination Date
Termination Reason
7/1/2021
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
3217 W Bavaria
Boise, ID 83616-5171
Billing Address
SAMG W Chinden Urgent Care
1055 N. Curtis Rd
Boise, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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