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CAH131323-00 ST. LUKE'S WOOD RIVER MEDICAL CENTER (Active)
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Main Details
Name
ST. LUKE'S WOOD RIVER MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131323-00
Medicare Provider Number
131323
Additional Details
Current Program Status
Active
Registration Date
2/14/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/2/2011
Last Recertification Date
8/28/2024
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
100 HOSPITAL DRIVE
KETCHUM, ID 83340
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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