340B Drug Pricing Program Database
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DSH130006DM ST LUKES REGIONAL MEDICAL CENTER, LTD. (Terminated)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
ST LUKES CLINIC PALLIATIVE MEDICINE/PALLATIVE AND SUPPORTIVE CARE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006DM
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/14/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/22/2014
Last Recertification Date
9/8/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
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
520 S. EAGLE RD. STE 3102
MERIDIAN, ID 83642
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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June 2025
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