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DSH130013F Saint Alphonsus Medical Center Nampa (Terminated)
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Main Details
Name
Saint Alphonsus Medical Center Nampa
Subdivision Name
Medical Cardiology Observation
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130013F
Medicare Provider Number
130013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/5/2016
Last Recertification Date
8/24/2023
Termination Date
Termination Reason
7/1/2024
Outpatient facility moved within the 4 walls of the parent hospital
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 Avenue
Nampa, ID 83687
Billing Address
Saint Alphonsus Medical Center Nampa
4400 E. Flamingo Ave
Nampa, ID 83687
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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