340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH130006MF ST LUKES REGIONAL MEDICAL CENTER, LTD. (Terminated)
Print
Main Details
Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
MRHL-ST LUKE'S IMAGING CTR-PORTICO - PORTICO WEST INTERVENTIONAL RADIOLOGY MERIDIAN
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH130006MF
Medicare Provider Number
130006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/12/2018
Participating Start Date
1/1/2019
Participating Approval Date
10/16/2018
Last Recertification Date
9/4/2020
Termination Date
Termination Reason
10/1/2021
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
3277 E LOUISE DRIVE SUITE 100
MERIDIAN, ID 83642
Billing Address
ST. LUKE'S HEALTH SYSTEM, LTD
190 E BANNOCK
BOISE, ID 83712
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
June 2025
June 2025
week
S
M
T
W
T
F
S
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
24
8
9
10
11
12
13
14
25
15
16
17
18
19
20
21
26
22
23
24
25
26
27
28
27
29
30
1
2
3
4
5
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session