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DSH130007EJ Saint Alphonsus Regional Medical Center (Active)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG GLYCEMIC CALDWELL - GLYCEMIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007EJ
Medicare Provider Number
130007
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/16/2017
Participating Start Date
1/1/2018
Participating Approval Date
11/20/2017
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
1906 FAIRVIEW AVE STE 430
CALDWELL, ID 83605
Billing Address
SAINT ALPHONSUS REGIONAL MEDICAL CENTER
ATTN: SAMG GLYCEMIC CALDWELL
1055 N CURTIS RD
BOISE, ID 83706
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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