340B Drug Pricing Program Database


CAH131312-23 ST. LUKE'S MCCALL, LTD (Approved) - information as of 4/28/2025 4:05:38 AM

Main Details
ST. LUKE'S MCCALL, LTD
ST LUKES MCCALL MEDICAL CENTER - ST LUKES CLINIC-PAIN MANAGEMENT
Critical Access Hospital
Yes
CAH131312-23
131312


Additional Details
Approved
4/1/2025
7/1/2025
4/4/2025

Contacts

St. Luke's Health System, LTD
Kate Fowler, Senior VP & CFO
(208) 381-8717

St. Luke's Health System, LTD
Amanda Davis, Pharmacy Business Analyst
(208) 706-1021

Addresses

211 FOREST ST
MCCALL, ID 83638-5256

St. Luke's Health System, LTD
190 E Bannock St.
BOISE, ID 83712


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

ST. LUKE'S MCCALL, LTD
ATTN: PHARMACY
1000 STATE STREET
MCCALL, ID 83638
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
CAH131312-01ChildCAHST. LUKE'S MCCALL, LTDST. LUKE'S CLINIC-MCCALL ORTHO SURGERY CLINIC200 FOREST ST.MCCALLIDActive
CAH131312-02ChildCAHST. LUKE'S MCCALL, LTDMCCALL GENERAL SURGERY CLINIC200 FOREST ST.MCCALLIDActive
CAH131312-03ChildCAHST. LUKE'S MCCALL, LTDST LUKE'S CLINIC-MCCALL MEDICAL CLINIC209 FOREST ST.MCCALLIDActive
CAH131312-04ChildCAHST. LUKE'S MCCALL, LTDPAYETTE LAKES MEDICAL CLINIC-DL ST LUKES INTEGRATIVE MEDICINE301 Deinhard LaneMCCALLIDTerminated
CAH131312-05ChildCAHST. LUKE'S MCCALL, LTDST LUKE'S CLINIC- PAYETTE LAKES MEDICAL CLINIC FAMILY MEDICINE211 FOREST ST.MCCALLIDActive
CAH131312-06ChildCAHST. LUKE'S MCCALL, LTDSL MEADOWS VALLEY MEDICAL CLINIC320 VIRGINIA ST.NEW MEADOWSIDActive
CAH131312-07ChildCAHST. LUKE'S MCCALL, LTDST LUKES CLINC PAYETTE LAKE MEDICAL CLINIC / MOUNTAIN STATES UROLOGY-MCCALL211 Forest St.McCallIDActive
CAH131312-08ChildCAHST. LUKE'S MCCALL, LTDSleep Lab - McCall St Lukes Sleep Medicine Institute-McCall200 Forest StreetMcCallIDTerminated
CAH131312-09ChildCAHST. LUKE'S MCCALL, LTDMcCall Clinics - McCall Clinics/Payette Lakes Medical Clinic St. Lukes Integrative Medicine211 Forest St.McCallIDTerminated
CAH131312-10ChildCAHST. LUKE'S MCCALL, LTDPAYETTE LAKES MEDICAL CLINIC - ST LUKES OBSTETRICS AND GYNECOLOGY -MCCALL211 FOREST STREETMcCallIDActive
CAH131312-11ChildCAHST. LUKE'S MCCALL, LTDST LUKE'S CLINIC-SALMON RIVER FAMILY MEDICINE214 MAIN STREETRigginsIDActive
CAH131312-12ChildCAHST. LUKE'S MCCALL, LTDST LUKE'S CLINIC - MCCALL MEDICAL CLINIC WOUND CARE209 FOREST ST.MCCALLIDActive
CAH131312-13ChildCAHST. LUKE'S MCCALL, LTDPHYSICAL THERAPY - SALMON RIVER MEDICAL CENTER ST LUKES PHYSICAL THERAPY-RIGGINS214 N MAIN STREETRIGGINSIDActive
CAH131312-14ChildCAHST. LUKE'S MCCALL, LTDST LUKE'S CLINIC - BEHAVIORAL HEALTH MCCALL301 DEINHARD LANEMCCALLIDActive
CAH131312-15ChildCAHST. LUKE'S MCCALL, LTDPAYETTE LAKES MEDICAL CLINIC - MEADOWS VALLEY MEDICAL CLINIC INTEGRATIVE MEDICINE NEW MEADOWS320 VIRGINIA AVENUENEW MEADOWSIDTerminated
CAH131312-16ChildCAHST. LUKE'S MCCALL, LTDPAYETTE LAKES MEDICAL CLINIC - PLMC ST LUKE'S IDAHO CARDIOLOGY ASSOCIATES-MCCALL211 FOREST STREETMCCALLIDActive
CAH131312-17ChildCAHST. LUKE'S MCCALL, LTDST LUKE'S CLINIC-MCCALL MEDICAL CLINIC CLINICAL ONCOLOGY209 FOREST STREETMCCALLIDActive
CAH131312-18ChildCAHST. LUKE'S MCCALL, LTDPAYETTE LAKES MEDICAL CLINIC - ST LUKES RHEUMATOLOGY-MCCALL211 FOREST ST.MCCALLIDTerminated
CAH131312-19ChildCAHST. LUKE'S MCCALL, LTDPAYETTE LAKES MEDICAL CLINIC - ST LUKES CLINIC CHILDRENS CARDIOLOGY-MCCALL211 FOREST ST.MCCALLIDTerminated
CAH131312-20ChildCAHST. LUKE'S MCCALL, LTDST LUKES PAYETTE LAKES MEDICAL CLINIC - ST LUKES CLINIC DERMATOLOGY211 FOREST ST.MCCALLIDActive
CAH131312-21ChildCAHST. LUKE'S MCCALL, LTDST LUKES CLINIC BEHAVIORAL HEALTH - NEUROPSYCHOLOGY301 DEINHARD LNMCCALLIDActive
CAH131312-22ChildCAHST. LUKE'S MCCALL, LTDST LUKE'S CLINIC MCCALL - QUICKCARE MCCALL200 FOREST ST.MCCALLIDActive
CAH131312-23ChildCAHST. LUKE'S MCCALL, LTDST LUKES MCCALL MEDICAL CENTER - ST LUKES CLINIC-PAIN MANAGEMENT211 FOREST STMCCALLIDApproved
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsSigned ByInsertNew Registration Fowler, Kate Senior VP & CFO St. Luke's Health System, LTD 20838187174/4/2025 9:04 AM
Details340B IDUpdateNew Registration CAH131312-234/4/2025 9:04 AM
DetailsEntity SubnameUpdateNew RegistrationST LUKES MCCALL MEDICAL CENTERST LUKES MCCALL MEDICAL CENTER - ST LUKES CLINIC-PAIN MANAGEMENT4/4/2025 9:04 AM
DatesParticipating Approval DateUpdateNew Registration 4/4/2025 9:04:16 AM4/4/2025 9:04 AM
DetailsStateUpdateNew RegistrationPendingApproved4/4/2025 9:04 AM
DatesSigned By DateUpdateNew Registration 4/3/2025 4:52:23 PM4/4/2025 9:04 AM
DatesStart DateUpdateNew Registration 7/1/2025 12:00:00 AM4/4/2025 9:04 AM
AddressesMain AddressInsertNew Registration  211 FOREST ST MCCALL, ID 83638-52564/1/2025 12:06 PM
AddressesBilling AddressInsertNew Registration St. Luke's Health System, LTD 190 E Bannock St. BOISE, ID 837124/1/2025 12:06 PM
AddressesShipping AddressInsertNew Registration ST. LUKE'S MCCALL, LTD ATTN: PHARMACY 1000 STATE STREET MCCALL, ID 836384/1/2025 12:06 PM
ContactsPrimary ContactInsertNew Registration Davis, Amanda Pharmacy Business Analyst St. Luke's Health System, LTD 20870610214/1/2025 12:06 PM
ContactsAuthorizing OfficialInsertNew Registration Fowler, Kate Senior VP & CFO St. Luke's Health System, LTD 20838187174/1/2025 12:06 PM
DetailsAssistance Received From DateInsertNew Registration  4/1/2025 12:06 PM
DetailsAssistance Received To DateInsertNew Registration  4/1/2025 12:06 PM
DetailsLast Recertification DateInsertNew Registration  4/1/2025 12:06 PM
DetailsGrant NumberInsertNew Registration  4/1/2025 12:06 PM
Details340B IDInsertNew Registration  4/1/2025 12:06 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  4/1/2025 12:06 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  4/1/2025 12:06 PM
DetailsMedicare Provider NumberInsertNew Registration 1313124/1/2025 12:06 PM
DetailsEntity NameInsertNew Registration ST. LUKE'S MCCALL, LTD4/1/2025 12:06 PM
DetailsNOFO NumberInsertNew Registration  4/1/2025 12:06 PM
DetailsProgram CodeInsertNew Registration CAH4/1/2025 12:06 PM
DetailsEntity SubnameInsertNew Registration ST LUKES MCCALL MEDICAL CENTER4/1/2025 12:06 PM
DatesParticipating Approval DateInsertNew Registration  4/1/2025 12:06 PM
DetailsStateInsertNew Registration Pending4/1/2025 12:06 PM
DatesRegistration DateInsertNew Registration 4/1/2025 12:06:39 PM4/1/2025 12:06 PM
DatesSigned By DateInsertNew Registration  4/1/2025 12:06 PM
DatesStart DateInsertNew Registration  4/1/2025 12:06 PM
TerminationsTermination CommentsInsertNew Registration  4/1/2025 12:06 PM
TerminationsTermination DateInsertNew Registration  4/1/2025 12:06 PM
TerminationsTermination Effective DateInsertNew Registration  4/1/2025 12:06 PM
TerminationsTermination ReasonInsertNew Registration  4/1/2025 12:06 PM