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CAH131311-08 ST. LUKE'S ELMORE MEDICAL CENTER (Active)
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Main Details
Name
ST. LUKE'S ELMORE MEDICAL CENTER
Subdivision Name
ELMORE ST LUKES FAMILY/INTERNAL MEDICINE CLINIC
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH131311-08
Medicare Provider Number
131311
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/31/2022
Participating Start Date
7/1/2022
Participating Approval Date
6/1/2022
Last Recertification Date
8/29/2024
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
805 N 6TH STREET E
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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Participated starting 7/1/2019, terminated 1/1/2022. Reinstated 7/1/2022.
06/01/2022
May 2025
May 2025
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