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DSH130007DU Saint Alphonsus Regional Medical Center (Terminated)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG Cancer Pain Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007DU
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/27/2017
Last Recertification Date
9/13/2021
Termination Date
Termination Reason
7/1/2022
Outpatient facility moved within the 4 walls of the parent hospital
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
1055 N Curtis Rd
Boise, ID 83706
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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