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CAH131319-01 Minidoka Memorial Hospital (Active)
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Main Details
Name
Minidoka Memorial Hospital
Subdivision Name
Minidoka Medical - RHC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131319-01
Medicare Provider Number
131319
Outpatient Facility Provider Number
138507
Additional Details
Current Program Status
Active
Registration Date
7/8/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/8/2016
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Minidoka Memorial Hospital
Thomas J Murphy, CEO
(208) 436-8141
Primary Contact
Minidoka Memorial Hospital
David dward@minidokamemorial.com Ward, Pharmacy Director
(208) 436-0481 Ext: 2504
Addresses
Street Address
1308 8th Street 1
Rupert, ID 83350
Billing Address
Minidoka Memorial Hospital
1224 8th Street
Rupert, ID 83350
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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