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SCH130002-46 St. Luke's Magic Valley Regional Medical Center, LTD (Active)
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Main Details
Name
St. Luke's Magic Valley Regional Medical Center, LTD
Subdivision Name
MVHL-HOME HEALTH - HOME CARE MAGIC VALLEY
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH130002-46
Medicare Provider Number
130002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/19/2018
Last Recertification Date
8/28/2024
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
601 POLE LINE RD
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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