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DSH380052D SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC. (Terminated)
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Main Details
Name
SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC.
Subdivision Name
SAMG PODIATRY FHP
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380052D
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
8/30/2018
Termination Date
Termination Reason
4/1/2019
Change of covered entity type
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
910 NW 16th Street
STE 102
Fruitland, ID 83619-2627
Billing Address
Saint Alphonsus Medical Center - ONT
SAMG Podiatry OHP
351 SW 9th Street
Ontario, OR 97914
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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