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DSH130006KP ST LUKES REGIONAL MEDICAL CENTER, LTD. (Terminated)
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Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
Mountain States Tumor Institute Mole Mapping - Anderson Center Mole Mapping Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006KP
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/19/2018
Last Recertification Date
9/6/2019
Termination Date
Termination Reason
1/1/2020
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
100 E IDAHO STREET
Boise, ID 83712
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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June 2025
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