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CAH131310-00 St Luke's Jerome, Ltd. (Active)
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Main Details
Name
St Luke's Jerome, Ltd.
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131310-00
Medicare Provider Number
131310
Additional Details
Current Program Status
Active
Registration Date
8/13/2010
Participating Start Date
9/30/2010
Participating Approval Date
9/30/2010
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
709 NORTH LINCOLN AVE
JEROME, ID 83338
Billing Address
St. Luke's Health System, LTD
190 E Bannock
Boise, ID 83712
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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12/16/11 - Updated Entity Name (was St.Benedicts Family Medical Center)
08/13/2010
April 2025
April 2025
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