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ST LUKE'S MERIDIAN MEDICAL
DSH130071 St. Luke's Nampa Medical Center
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Covered Entity Details
Entity Name
St. Luke's Nampa Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH130071
Entity Address
9850 W ST LUKES DRIVE
Nampa, ID 83687
Medicare Provider Number
130071
Participating Start Date
7/1/2019
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
ST LUKE'S MERIDIAN MEDICAL
Pharmacy Address
CENTER PHARMACY
520 S EAGLE RD STE 1000
MERIDIAN, ID 83642-6353
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
St. Luke's Nampa Medical Center, LTD
Steven Nadler, Pharmacy Outpatient Director
(208) 381-4354
Signed By Date
4/12/2019
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