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DSH130006BJ ST LUKES REGIONAL MEDICAL CENTER, LTD. (Terminated)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
ST LUKES NEUROSURGERY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006BJ
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
3/29/2012
Last Recertification Date
9/12/2021
Termination Date
Termination Reason
7/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
St. Lukes Regional Medical Center
Peter DiDio, Vice President, Controller
(208) 381-1251
Primary Contact
St. Luke's Health System, LTD
Amanda Davis, Pharmacy Business Analyst
(208) 706-1021
Addresses
Street Address
222 N. 2ND St. Ste 307
BOISE, ID 83702
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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