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DSH130007EF Saint Alphonsus Regional Medical Center (Active)
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Main Details
Name
Saint Alphonsus Regional Medical Center
Subdivision Name
SAMG OBGYN GLOBAL HEALTH
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130007EF
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
11/17/2017
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
6533 W EMERALD ST
BOISE, ID 83704
Billing Address
SAINT ALPHONSUS REGIONAL MEDICAL CENTER
ATTN: SAMG OBGYN GLOBAL HEALTH
1055 N CURTIS RD
BOISE, ID 83706
Comments
Medicaid Billing
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Contract Pharmacies
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