340B Drug Pricing Program Database
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CAH131312-08 ST. LUKE'S MCCALL, LTD (Terminated)
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Main Details
Name
ST. LUKE'S MCCALL, LTD
Subdivision Name
Sleep Lab - McCall St Lukes Sleep Medicine Institute-McCall
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131312-08
Medicare Provider Number
131312
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/13/2018
Last Recertification Date
9/16/2022
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
200 Forest Street
McCall, ID 83638
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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