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SCH130002-71 St. Luke's Magic Valley Regional Medical Center, LTD (Approved)
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Main Details
Name
St. Luke's Magic Valley Regional Medical Center, LTD
Subdivision Name
ST LUKES RADIOLOGY - INTERVENTIONAL RADIOLOGY
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH130002-71
Medicare Provider Number
130002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/1/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/4/2025
Last Recertification Date
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
625 POLE LINE RD W STE 1A
TWIN FALLS, ID 83301
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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May 2025
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