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DSH380052K SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC. (Terminated)
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Main Details
Name
SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC.
Subdivision Name
SAMG Riverside Orthopedics - Orthopedics
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH380052K
Medicare Provider Number
380052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/13/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/19/2017
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 St
STE 205
Fruitland, ID 83619
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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