340B Drug Pricing Program Database
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CAH131312-12 ST. LUKE'S MCCALL, LTD (Active)
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Main Details
Name
ST. LUKE'S MCCALL, LTD
Subdivision Name
ST LUKE'S CLINIC - MCCALL MEDICAL CLINIC WOUND CARE
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131312-12
Medicare Provider Number
131312
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/16/2018
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
209 FOREST ST.
MCCALL, ID 83638
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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