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DSH130006JE ST LUKES REGIONAL MEDICAL CENTER, LTD. (Active)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
Imaging Center / Fruitland Medical Center Nuclear Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006JE
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/6/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/7/2021
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
1210 NW 16th Street
Fruitland, ID 83619
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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Participating Start Date 10/1/2016, Termination Date 7/1/2021, Reinstatement 1/1/2022
10/07/2021
June 2025
June 2025
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