340B Drug Pricing Program Database
KWIK-MEDS
CAH131310-00 St Luke's Jerome, Ltd. - information as of 4/28/2025 1:05:18 AM
Covered Entity Details
Entity Name
St Luke's Jerome, Ltd.
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131310-00
Entity Address
709 NORTH LINCOLN AVE
JEROME, ID 83338
Medicare Provider Number
131310
Participating Start Date
9/30/2010
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
KWIK-MEDS
Pharmacy Address
K2RED LLC
256 OVERLAND AVE
BURLEY, ID 83318-1023
Pharmacy Comments
Contract Details
Approval Date
10/10/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
K2RED L.L.C
Dan Fuchs, Member
(208) 734-7373
Signed By Date
10/10/2017
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