340B Drug Pricing Program Database
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CAH131312-15 ST. LUKE'S MCCALL, LTD (Terminated)
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Main Details
Name
ST. LUKE'S MCCALL, LTD
Subdivision Name
PAYETTE LAKES MEDICAL CLINIC - MEADOWS VALLEY MEDICAL CLINIC INTEGRATIVE MEDICINE NEW MEADOWS
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131312-15
Medicare Provider Number
131312
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2019
Participating Start Date
7/1/2019
Participating Approval Date
4/29/2019
Last Recertification Date
8/31/2020
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
320 VIRGINIA AVENUE
NEW MEADOWS, ID 83654
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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