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CAH131311-02 ELMORE MEDICAL CENTER (Terminated)
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Main Details
Name
ELMORE MEDICAL CENTER
Subdivision Name
General Surgery Clinic - ClinicElmore St. Lukes General Surgery Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131311-02
Medicare Provider Number
131311
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/12/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/24/2018
Last Recertification Date
Termination Date
Termination Reason
7/1/2018
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
840 N 4TH E STREET
Mountain Home, ID 83647
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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