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DSH130007DX Saint Alphonsus Regional Medical Center (Active)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG 12th Avenue Family Medicine
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007DX
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/27/2017
Last Recertification Date
8/20/2024
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
1510 12th Ave Rd STE 200
NAMPA, ID 83686-2834
Billing Address
SAMG 12th Avenue Family Medicine
1510 12th Ave
Ste 200
Nampa, ID 83686
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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