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CAH131314-00 SHOSHONE MEDICAL CENTER (Active)
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Main Details
Name
SHOSHONE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131314-00
Medicare Provider Number
131314
Additional Details
Current Program Status
Active
Registration Date
7/17/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/31/2018
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Shoshone Medical Center
Donja C Erdman, Chief Financial Officer
(208) 784-1221
Primary Contact
Shoshone Medical Center
Alicia Mitchell, Pharmacy Tech
(208) 784-7017 Ext: 349
Addresses
Street Address
25 jacobs Gulch
KELLOGG, ID 83837
Billing Address
Shoshone Medical Center
25 Jacobs Gulch
Kellogg, ID 83837
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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