340B Drug Pricing Program Database
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DSH130071AA St. Luke's Nampa Medical Center (Active)
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Main Details
Name
St. Luke's Nampa Medical Center
Subdivision Name
ST LUKES CLINIC/CARDIOLOGY - NMOP SL PROCEDURAL SLICA - NAMPA
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130071AA
Medicare Provider Number
130071
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/5/2024
Participating Start Date
7/1/2024
Participating Approval Date
5/1/2024
Last Recertification Date
8/27/2024
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
9850 W ST LUKES DR STE 180
NAMPA, ID 83687
Billing Address
St. Luke's Health System, LTD
190 E Bannock St.
Boise, ID 83712
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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