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DSH130006AA ST LUKES REGIONAL MEDICAL CENTER, LTD. (Terminated)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
SL METABOLIC AND BARIATRIC SURG
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006AA
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/1/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/12/2012
Last Recertification Date
8/17/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
St. Lukes Regional Medical Center
Peter DiDio, Vice President, Controller
(208) 381-1251
Primary Contact
Dawn Berheim, Senior Director of Pharmacy
(208) 381-7194
Addresses
Street Address
333 N 1ST ST, STE 120
BOISE, ID 83702
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
June 2025
June 2025
week
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