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CAH131302-00 NORTH CANYON MEDICAL CENTER (Active)
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Main Details
Name
NORTH CANYON MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131302-00
Medicare Provider Number
131302
Additional Details
Current Program Status
Active
Registration Date
7/17/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/25/2017
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
North Canyon Medical Center
Sara DeMoe, Controller
(208) 934-4433 Ext: 1201
Primary Contact
North Canyon Medical Center
Greg Olsen, Pharmacist
(208) 934-4433 Ext: 1195
Addresses
Street Address
267 NORTH CANYON DRIVE
GOODING, ID 83330
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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