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DSH130006 ST LUKES REGIONAL MEDICAL CENTER, LTD. (Active)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006
Medicare Provider Number
130006
Additional Details
Current Program Status
Active
Registration Date
4/21/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/21/2008
Last Recertification Date
8/29/2024
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
190 EAST BANNOCK
BOISE, ID 83712
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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03/20/2014: Termination recorded in error; site remained continuously eligible from participation start date.
03/31/2014
April 2025
April 2025
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