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DSH130007DJ ST. ALPHONSUS REGIONAL MED CENTER (Terminated)
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Main Details
Name
ST. ALPHONSUS REGIONAL MED CENTER
Subdivision Name
SAMG Boise Pediatrics Kuna / Pediatrics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007DJ
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
8/18/2016
Termination Date
Termination Reason
1/1/2017
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
757 E Wythe Creek Ct
Kuna, ID 83634-5006
Billing Address
SAMG Boise Pediatrics Kuna
1055 N. Curtis Rd
Boise, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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