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DSH130006LZ ST LUKES REGIONAL MEDICAL CENTER, LTD. (Active)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
St. Lukes Psychiatric Wellness Services - Portico St. Lukes Psychiatric Wellness Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006LZ
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/4/2018
Last Recertification Date
8/14/2024
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
3399 E Louise Drive Suite 100
Meridian, ID 83642
Billing Address
St. Luke's Health System LTD
190 E Bannock St.
BOISE, ID 83712
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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