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DSH130006HZ ST LUKES REGIONAL MEDICAL CENTER, LTD. (Terminated)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
ST. LUKES REHAB ADULT - MYRTLE / Pioneer Plaza St Lukes Rehab-Ortho-Myrtle
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006HZ
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/13/2016
Participating Start Date
10/1/2016
Participating Approval Date
9/14/2016
Last Recertification Date
11/15/2017
Termination Date
Termination Reason
4/1/2018
Site closure
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
1109 W MYRTLE SUITE 200
Boise, ID 83702
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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