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DSH130006AU ST LUKES REGIONAL MEDICAL CENTER, LTD. (Active)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
PEDIATRIC GENETICS CLINIC-ST LUKES CHILDRENS GENETICS AND METABOLICS-BOISE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006AU
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/1/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/12/2012
Last Recertification Date
8/14/2024
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
305 E JEFFERSON STREET
BOISE, ID 83712
Billing Address
St. Lukes Health System, LTD
190 E Bannock
Boise, ID 83712
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
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