340B Drug Pricing Program Database
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SCH130002-42 St. Luke's Magic Valley Regional Medical Center, LTD (Terminated)
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Main Details
Name
St. Luke's Magic Valley Regional Medical Center, LTD
Subdivision Name
ST LUKES PHYS MED AND REHAB - Magic Valley Plaza 2 St. Lukes Clinic Spine Care-TWIN FALLS
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH130002-42
Medicare Provider Number
130002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
5/2/2018
Last Recertification Date
9/12/2021
Termination Date
Termination Reason
10/1/2022
Business decision by the Covered Entity
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
625 Pole Line Road Suite 1A
Twin Falls, ID 83301
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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