Covered Entity Details

CAH131312-00 ST. LUKE'S MCCALL, LTD (Active) - information as of 4/25/2025 6:32:44 PM

Main Details

Name

ST. LUKE'S MCCALL, LTD

Subdivision Name

Type

Critical Access Hospital

Rural

Yes

340B ID

CAH131312-00

Medicare Provider Number

131312

Additional Details

Current Program Status

Active

Registration Date

10/15/2012

Participating Start Date

1/1/2013

Participating Approval Date

11/6/2012

Last Recertification Date

8/28/2024

Contacts

Authorizing Official

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

Primary Contact

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

Addresses

Street Address

1000 State Street
MCCALL, ID 83638

Billing Address

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

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

St. Luke's McCall, LTD.
Attn: Pharmacy
1000 State St.
McCall, ID 83638

Shipping Address 2

St Lukes Central Pharmacy
703 S Black Cat Rd, Suite 130
Meridian, ID 83642

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ALBERTSONS LLC	SAV-ON PHARMACY #3360	132 EAST LAKE ST.	MCCALL	ID	83638	10/16/2017	01/01/2018		10/16/2017
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/17/2023	07/01/2023		07/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	13925 YALE AVE STE 145		IRVINE	CA	92620-2670	04/17/2023	07/01/2023		07/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/17/2023	07/01/2023		07/01/2023
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4740 VICTORY LN STE C	INDIANAPOLIS	IN	46203	10/01/2024	01/01/2025		01/01/2025
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	145 S 79TH ST STE 70	CHANDLER	AZ	85226	10/01/2024	01/01/2025		01/01/2025
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	01/12/2021	04/01/2021		04/01/2021
Contract Detail	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	07/30/2021	10/01/2021		10/01/2021
Contract Detail	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	07/30/2021	10/01/2021		10/01/2021
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/12/2021	04/01/2021		04/01/2021
Contract Detail	DOGWOOD PHARMACY LLC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER RD STE K	GREENVILLE	SC	29607-6541	04/17/2023	07/01/2023		07/01/2023
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/12/2021	04/01/2021		04/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/12/2021	04/01/2021		04/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/12/2021	04/01/2021		04/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	01/12/2021	04/01/2021		04/01/2021
Contract Detail	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2926	1001 MADISON ST.	SEATTLE	WA	98104	01/12/2021	04/01/2021		04/01/2021
Contract Detail	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	04/17/2023	07/01/2023		07/01/2023
Contract Detail	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	04/17/2023	07/01/2023		07/01/2023
Contract Detail	SANTA BARBARA SPECIALTY PHARMACY LLC	4690 CARPINTERIA AVE STE B		CARPINTERIA	CA	93013	04/17/2023	07/01/2023		07/01/2023
Contract Detail	ST LUKE'S HEALTH SYSTEM	SPECIALTY PHARMACY	11801 W EXECUTIVE DR	BOISE	ID	83713	10/10/2022	11/01/2022		11/01/2022
Contract Detail	ST LUKE'S MERIDIAN MEDICAL	CENTER PHARMACY	520 S EAGLE RD STE 1000	MERIDIAN	ID	83642-6353	10/10/2022	11/01/2022		11/01/2022
Contract Detail	WATKINS PHARMACY INC	220 S MAIN ST		CASCADE	ID	83611	04/11/2019	07/01/2019	01/12/2024	01/14/2024

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
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

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Update	Change Request	St Lukes Central Pharmacy 703 Black Cat Rd, Suite 130 Meridian, ID 83642	St Lukes Central Pharmacy 703 S Black Cat Rd, Suite 130 Meridian, ID 83642	10/23/2024 2:24 PM
Addresses	Shipping Address	Insert	Change Request		St Lukes Central Pharmacy 703 Black Cat Rd, Suite 130 Meridian, ID 83642	10/2/2024 10:17 AM
Details	Last Recertification Date	Update	Recertification	8/23/2023 3:33:07 PM	8/28/2024 1:27:56 PM	8/28/2024 1:27 PM
Details	Last Recertification Date	Update	Recertification	8/30/2022 7:57:31 AM	8/23/2023 3:33:07 PM	8/23/2023 3:33 PM
Contacts	Authorizing Official	Update	Change Request	DiDio, Peter Vice President, Controller St. Lukes Regional Medical Center 2083811251	Fowler, Kate Senior VP & CFO St. Luke's Health System, LTD 2083818717	11/16/2022 8:27 AM
Contacts	Primary Contact	Update	Profile Change Request	Davis, Amanda Pharmacy Business Specialist St. Lukes Regional Medical Center 2087061021	Davis, Amanda Pharmacy Business Analyst St. Luke's Health System, LTD 2087061021	11/15/2022 9:54 AM
Details	Last Recertification Date	Update	Recertification	9/13/2021 6:53:44 AM	8/30/2022 7:57:31 AM	8/30/2022 7:57 AM
Details	Last Recertification Date	Update	Recertification	9/1/2020 1:17:06 PM	9/13/2021 6:53:44 AM	9/13/2021 6:53 AM
Details	Last Recertification Date	Update	Recertification	9/6/2019 1:21:01 AM	9/1/2020 1:17:06 PM	9/1/2020 1:17 PM
Details	Last Recertification Date	Update	Recertification	8/28/2018 6:55:02 AM	9/6/2019 1:21:01 AM	9/6/2019 1:21 AM
Addresses	Billing Address	Insert	Change Request		St. Luke's Health System, LTD 190 E Bannock St. Boise, ID 83712	6/25/2019 10:13 AM
Addresses	Shipping Address	Insert	Change Request		St. Luke's McCall, LTD. Attn: Pharmacy 1000 State St. McCall, ID 83638	6/25/2019 10:13 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 3:44:47 PM	8/28/2018 6:55:02 AM	8/28/2018 6:55 AM
Contacts	Primary Contact	Update	Change Request	Jackson, Shana E Pharmacy Business Analyst St. Luke's Magic Valley Regional Medical Center 2088149611	Davis, Amanda Pharmacy Business Specialist St. Lukes Regional Medical Center 2087061021	3/29/2018 10:47 AM
Contacts	Primary Contact	Update	Recertification	Davis, Amanda Pharmacy Business Specialist St. Lukes Regional Medical Center 2087061021	Jackson, Shana E Pharmacy Business Analyst St. Luke's Magic Valley Regional Medical Center 2088149611	11/15/2017 3:44 PM
Details	Last Recertification Date	Update	Recertification	8/19/2016 12:00:00 AM	11/15/2017 3:44:47 PM	11/15/2017 3:44 PM
Contacts	Primary Contact	Insert	Change Request		Davis, Amanda Pharmacy Business Specialist St. Lukes Regional Medical Center 2087061021	10/5/2017 10:52 AM
Contacts	Authorizing Official	Update		DiDio, Peter Vice President, Controller 2083811251	DiDio, Peter Vice President, Controller St. Lukes Regional Medical Center 2083811251	10/4/2017 2:42 PM
Contacts	Authorizing Official	Insert			DiDio, Peter Vice President, Controller 2083811251	8/10/2017 3:00 PM
Contacts	Signed By	Insert			Fenello, Michael CEO 2086302204	5/3/2017 12:03 PM
Addresses	Main Address	Insert			1000 State Street MCCALL, ID 83638	5/3/2017 12:03 PM
Details	Last Recertification Date	Update		8/12/2015 12:00:00 AM	8/19/2016 12:00:00 AM	8/22/2016 10:28 AM
Details	Last Recertification Date	Update		8/20/2014 12:00:00 AM	8/12/2015 12:00:00 AM	8/12/2015 10:49 AM
Details	Entity Name	Update		ST. LUKE’S MCCALL, LTD	ST. LUKE'S MCCALL, LTD	11/14/2014 1:43 PM
Details	Last Recertification Date	Update		8/28/2013 12:00:00 AM	8/20/2014 12:00:00 AM	8/20/2014 3:13 PM
Details	Last Recertification Date	Update		8/28/2013 10:06:28 AM	8/28/2013 12:00:00 AM	1/10/2014 9:53 AM
Details	Last Recertification Date	Update			8/28/2013 10:06:28 AM	8/28/2013 10:06 AM
Details	340B ID	Update		CAH1131312-00	CAH131312-00	1/3/2013 1:58 PM
Dates	Participating Approval Date	Update			11/6/2012 12:00:00 AM	11/6/2012 10:56 AM
Details	State	Update		Pending	Active	11/6/2012 10:56 AM
Dates	Start Date	Update			1/1/2013 12:00:00 AM	11/6/2012 10:56 AM
Details	340B ID	Update		ISDMCAH1131312-00	CAH1131312-00	11/6/2012 10:55 AM
Details	340B ID	Update		CAH1131312-00	ISDMCAH1131312-00	11/6/2012 9:00 AM
Details	340B ID	Update		DELETE102412	CAH1131312-00	10/26/2012 2:12 PM
Details	State	Update		Rejected	Pending	10/26/2012 2:12 PM
Details	340B ID	Update		DM101612B	DELETE102412	10/24/2012 4:00 PM
Details	State	Update		Pending	Rejected	10/24/2012 4:00 PM
Details	340B ID	Update		ONLINE_REG	DM101612B	10/16/2012 9:51 AM
Details	Last Recertification Date	Insert				10/15/2012 6:12 PM
Details	Grant Number	Insert				10/15/2012 6:12 PM
Details	340B ID	Insert			ONLINE_REG	10/15/2012 6:12 PM
Details	Is Authorizing Official EHB Data	Insert				10/15/2012 6:12 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/15/2012 6:12 PM
Details	Medicare Provider Number	Insert			131312	10/15/2012 6:12 PM
Details	Entity Name	Insert			ST. LUKE’S MCCALL, LTD	10/15/2012 6:12 PM
Details	Program Code	Insert			CAH	10/15/2012 6:12 PM
Details	Entity Subname	Insert				10/15/2012 6:12 PM
Dates	Participating Approval Date	Insert				10/15/2012 6:12 PM
Details	State	Insert			Pending	10/15/2012 6:12 PM
Dates	Registration Date	Insert			10/15/2012 12:00:00 AM	10/15/2012 6:12 PM
Dates	Signed By Date	Insert			10/15/2012 12:00:00 AM	10/15/2012 6:12 PM
Dates	Start Date	Insert				10/15/2012 6:12 PM
Terminations	Termination Comments	Insert				10/15/2012 6:12 PM
Terminations	Termination Date	Insert				10/15/2012 6:12 PM
Terminations	Termination Effective Date	Insert				10/15/2012 6:12 PM
Terminations	Termination Reason	Insert				10/15/2012 6:12 PM