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DSH380052G SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC. (Terminated)
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Main Details
Name
SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC.
Subdivision Name
SAMG OHP URGENT CARE / Urgent Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380052G
Medicare Provider Number
380052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/18/2017
Last Recertification Date
Termination Date
Termination Reason
10/1/2018
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
840 SW 4TH AVE
STE 105
ONTARIO, OR 97914-2627
Billing Address
Saint Alphonsus Medical Center- ONT
351 SW 9th Street
Ontario, OR 97914
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2016, terminated 4/1/2017. Reinstated 1/1/2018.
10/18/2017
June 2025
June 2025
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