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ST. LUKE'S NAMPA MEDICAL CENTER
CAH131323-00 ST. LUKE'S WOOD RIVER MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. LUKE'S WOOD RIVER MEDICAL CENTER
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131323-00
Entity Address
100 HOSPITAL DRIVE
KETCHUM, ID 83340
Medicare Provider Number
131323
Participating Start Date
4/1/2011
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
ST. LUKE'S NAMPA MEDICAL CENTER
Pharmacy Address
OUTPATIENT PHARMACY
9850 W ST LUKES DR
NAMPA, ID 83687
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
5/5/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2023
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
4/14/2021
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