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DSH380052B SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC. (Terminated)
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Main Details
Name
SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC.
Subdivision Name
SAMG FHP INTERNAL MEDICINE
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380052B
Medicare Provider Number
380052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/23/2016
Last Recertification Date
11/3/2017
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
910 NW 16TH ST
SUITE 102
FRUITLAND, ID 83619-2265
Billing Address
Saint Alphonsus Medical Center - ONT
FHP Internal Medicine
351 SW 9th Street
Ontario, OR 97914
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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