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DSH130006KR 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 INTEGRATIVE MEDICINE - FRUITLAND MEDICAL FACILITY MSTI INTEGRATIVE MEDICINE CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006KR
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
Termination Date
Termination Reason
10/1/2018
Never implemented the 340B Program
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
1118 NW 16TH STREET SUITE D
Fruitland, ID 83619
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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June 2025
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