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DSH130013J Saint Alphonsus Medical Center Nampa (Terminated)
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Main Details
Name
Saint Alphonsus Medical Center Nampa
Subdivision Name
SAMGP Pulmonary Garrity MOB
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH130013J
Medicare Provider Number
130013
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/8/2019
Participating Start Date
4/1/2019
Participating Approval Date
2/19/2019
Last Recertification Date
8/20/2024
Termination Date
Termination Reason
1/1/2025
DSH percentage below statutory minimum
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
4424 E Flamingo Ave Suite 210
Nampa, ID 83687
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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