No
ST. LUKE'S MCCALL, LTD
ATTN: PHARMACY
1000 STATE STREET
MCCALL, ID 83638
CAH131312-01 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST. LUKE'S CLINIC-MCCALL ORTHO SURGERY CLINIC | 200 FOREST ST. | MCCALL | ID | Active |
CAH131312-02 | Child | CAH | ST. LUKE'S MCCALL, LTD | MCCALL GENERAL SURGERY CLINIC | 200 FOREST ST. | MCCALL | ID | Active |
CAH131312-03 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKE'S CLINIC-MCCALL MEDICAL CLINIC | 209 FOREST ST. | MCCALL | ID | Active |
CAH131312-04 | Child | CAH | ST. LUKE'S MCCALL, LTD | PAYETTE LAKES MEDICAL CLINIC-DL ST LUKES INTEGRATIVE MEDICINE | 301 Deinhard Lane | MCCALL | ID | Terminated |
CAH131312-05 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKE'S CLINIC- PAYETTE LAKES MEDICAL CLINIC FAMILY MEDICINE | 211 FOREST ST. | MCCALL | ID | Active |
CAH131312-06 | Child | CAH | ST. LUKE'S MCCALL, LTD | SL MEADOWS VALLEY MEDICAL CLINIC | 320 VIRGINIA ST. | NEW MEADOWS | ID | Active |
CAH131312-07 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKES CLINC PAYETTE LAKE MEDICAL CLINIC / MOUNTAIN STATES UROLOGY-MCCALL | 211 Forest St. | McCall | ID | Active |
CAH131312-08 | Child | CAH | ST. LUKE'S MCCALL, LTD | Sleep Lab - McCall St Lukes Sleep Medicine Institute-McCall | 200 Forest Street | McCall | ID | Terminated |
CAH131312-09 | Child | CAH | ST. LUKE'S MCCALL, LTD | McCall Clinics - McCall Clinics/Payette Lakes Medical Clinic St. Lukes Integrative Medicine | 211 Forest St. | McCall | ID | Terminated |
CAH131312-10 | Child | CAH | ST. LUKE'S MCCALL, LTD | PAYETTE LAKES MEDICAL CLINIC - ST LUKES OBSTETRICS AND GYNECOLOGY -MCCALL | 211 FOREST STREET | McCall | ID | Active |
CAH131312-11 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKE'S CLINIC-SALMON RIVER FAMILY MEDICINE | 214 MAIN STREET | Riggins | ID | Active |
CAH131312-12 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKE'S CLINIC - MCCALL MEDICAL CLINIC WOUND CARE | 209 FOREST ST. | MCCALL | ID | Active |
CAH131312-13 | Child | CAH | ST. LUKE'S MCCALL, LTD | PHYSICAL THERAPY - SALMON RIVER MEDICAL CENTER ST LUKES PHYSICAL THERAPY-RIGGINS | 214 N MAIN STREET | RIGGINS | ID | Active |
CAH131312-14 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKE'S CLINIC - BEHAVIORAL HEALTH MCCALL | 301 DEINHARD LANE | MCCALL | ID | Active |
CAH131312-15 | Child | CAH | ST. LUKE'S MCCALL, LTD | PAYETTE LAKES MEDICAL CLINIC - MEADOWS VALLEY MEDICAL CLINIC INTEGRATIVE MEDICINE NEW MEADOWS | 320 VIRGINIA AVENUE | NEW MEADOWS | ID | Terminated |
CAH131312-16 | Child | CAH | ST. LUKE'S MCCALL, LTD | PAYETTE LAKES MEDICAL CLINIC - PLMC ST LUKE'S IDAHO CARDIOLOGY ASSOCIATES-MCCALL | 211 FOREST STREET | MCCALL | ID | Active |
CAH131312-17 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKE'S CLINIC-MCCALL MEDICAL CLINIC CLINICAL ONCOLOGY | 209 FOREST STREET | MCCALL | ID | Active |
CAH131312-18 | Child | CAH | ST. LUKE'S MCCALL, LTD | PAYETTE LAKES MEDICAL CLINIC - ST LUKES RHEUMATOLOGY-MCCALL | 211 FOREST ST. | MCCALL | ID | Terminated |
CAH131312-19 | Child | CAH | ST. LUKE'S MCCALL, LTD | PAYETTE LAKES MEDICAL CLINIC - ST LUKES CLINIC CHILDRENS CARDIOLOGY-MCCALL | 211 FOREST ST. | MCCALL | ID | Terminated |
CAH131312-20 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKES PAYETTE LAKES MEDICAL CLINIC - ST LUKES CLINIC DERMATOLOGY | 211 FOREST ST. | MCCALL | ID | Active |
CAH131312-21 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKES CLINIC BEHAVIORAL HEALTH - NEUROPSYCHOLOGY | 301 DEINHARD LN | MCCALL | ID | Active |
CAH131312-22 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKE'S CLINIC MCCALL - QUICKCARE MCCALL | 200 FOREST ST. | MCCALL | ID | Active |
CAH131312-23 | Child | CAH | ST. LUKE'S MCCALL, LTD | ST LUKES MCCALL MEDICAL CENTER - ST LUKES CLINIC-PAIN MANAGEMENT | 211 FOREST ST | MCCALL | ID | Approved |
Contacts | Signed By | Insert | New Registration | | Fowler, Kate
Senior VP & CFO
St. Luke's Health System, LTD
2083818717 | 4/4/2025 9:04 AM |
Details | 340B ID | Update | New Registration | | CAH131312-23 | 4/4/2025 9:04 AM |
Details | Entity Subname | Update | New Registration | ST LUKES MCCALL MEDICAL CENTER | ST LUKES MCCALL MEDICAL CENTER - ST LUKES CLINIC-PAIN MANAGEMENT | 4/4/2025 9:04 AM |
Dates | Participating Approval Date | Update | New Registration | | 4/4/2025 9:04:16 AM | 4/4/2025 9:04 AM |
Details | State | Update | New Registration | Pending | Approved | 4/4/2025 9:04 AM |
Dates | Signed By Date | Update | New Registration | | 4/3/2025 4:52:23 PM | 4/4/2025 9:04 AM |
Dates | Start Date | Update | New Registration | | 7/1/2025 12:00:00 AM | 4/4/2025 9:04 AM |
Addresses | Main Address | Insert | New Registration | |
211 FOREST ST
MCCALL, ID 83638-5256 | 4/1/2025 12:06 PM |
Addresses | Billing Address | Insert | New Registration | | St. Luke's Health System, LTD
190 E Bannock St.
BOISE, ID 83712 | 4/1/2025 12:06 PM |
Addresses | Shipping Address | Insert | New Registration | | ST. LUKE'S MCCALL, LTD
ATTN: PHARMACY
1000 STATE STREET
MCCALL, ID 83638 | 4/1/2025 12:06 PM |
Contacts | Primary Contact | Insert | New Registration | | Davis, Amanda
Pharmacy Business Analyst
St. Luke's Health System, LTD
2087061021 | 4/1/2025 12:06 PM |
Contacts | Authorizing Official | Insert | New Registration | | Fowler, Kate
Senior VP & CFO
St. Luke's Health System, LTD
2083818717 | 4/1/2025 12:06 PM |
Details | Assistance Received From Date | Insert | New Registration | | | 4/1/2025 12:06 PM |
Details | Assistance Received To Date | Insert | New Registration | | | 4/1/2025 12:06 PM |
Details | Last Recertification Date | Insert | New Registration | | | 4/1/2025 12:06 PM |
Details | Grant Number | Insert | New Registration | | | 4/1/2025 12:06 PM |
Details | 340B ID | Insert | New Registration | | | 4/1/2025 12:06 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/1/2025 12:06 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/1/2025 12:06 PM |
Details | Medicare Provider Number | Insert | New Registration | | 131312 | 4/1/2025 12:06 PM |
Details | Entity Name | Insert | New Registration | | ST. LUKE'S MCCALL, LTD | 4/1/2025 12:06 PM |
Details | NOFO Number | Insert | New Registration | | | 4/1/2025 12:06 PM |
Details | Program Code | Insert | New Registration | | CAH | 4/1/2025 12:06 PM |
Details | Entity Subname | Insert | New Registration | | ST LUKES MCCALL MEDICAL CENTER | 4/1/2025 12:06 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 4/1/2025 12:06 PM |
Details | State | Insert | New Registration | | Pending | 4/1/2025 12:06 PM |
Dates | Registration Date | Insert | New Registration | | 4/1/2025 12:06:39 PM | 4/1/2025 12:06 PM |
Dates | Signed By Date | Insert | New Registration | | | 4/1/2025 12:06 PM |
Dates | Start Date | Insert | New Registration | | | 4/1/2025 12:06 PM |
Terminations | Termination Comments | Insert | New Registration | | | 4/1/2025 12:06 PM |
Terminations | Termination Date | Insert | New Registration | | | 4/1/2025 12:06 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 4/1/2025 12:06 PM |
Terminations | Termination Reason | Insert | New Registration | | | 4/1/2025 12:06 PM |