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DSH130006CK ST LUKES REGIONAL MEDICAL CENTER, LTD. (Terminated)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
ST LUKES RHEUMATOLOGY-MERIDIAN-E LOUISE DR
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006CK
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/16/2013
Last Recertification Date
8/19/2016
Termination Date
Termination Reason
10/1/2016
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
3525 E LOUISE DR STE 250
MERIDIAN, ID 83642
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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