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DSH130006CN ST LUKES REGIONAL MEDICAL CENTER, LTD. (Active)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
ST LUKES CLINIC CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE/SPORTS MEDICINE FLOOR 1 &2
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006CN
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
5/16/2013
Last Recertification Date
8/29/2024
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
2619 W FAIRVIEW AVE STE 1104 and 2103
BOISE, ID 83702
Billing Address
St. Lukes Health System, LTD
190 E Bannock
Boise, ID 83702
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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