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CAH131311-00 ST. LUKE'S ELMORE MEDICAL CENTER (Active)
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Main Details
Name
ST. LUKE'S ELMORE MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131311-00
Medicare Provider Number
131311
Additional Details
Current Program Status
Active
Registration Date
10/16/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/17/2017
Last Recertification Date
8/27/2024
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
895 N. SIXTH EAST
MOUNTAIN HOME, ID 83647
Billing Address
St. Luke's Health System, LTD
190 E Bannock
Boise, ID 83712
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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