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SCH130002-67 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
ST LUKE'S - BEHAVIORAL HEALTH
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH130002-67
Medicare Provider Number
130002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/18/2022
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
228 SHOUP AVE W
TWIN FALLS, ID 83301
Billing Address
St. Luke's Health System, LTD
190 E Bannock St.
BOISE, ID 83712
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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