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DSH130006RP ST LUKES REGIONAL MEDICAL CENTER, LTD. (Approved)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
ST LUKES CLINIC PALLIATIVE AND SUPPORTIVE CARE - PALLIATIVE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006RP
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/7/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/24/2025
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
600 N ROBBINS RD STE 100
BOISE, ID 83702
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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April 2025
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