340B Drug Pricing Program Database
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DSH130006GV ST LUKES REGIONAL MEDICAL CENTER, LTD. (Terminated)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
SLC Perioperative Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006GV
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/7/2015
Last Recertification Date
9/6/2019
Termination Date
Termination Reason
4/1/2020
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
520 S EAGLE ROAD SUITE 2104
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
June 2025
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