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ST LUKE'S HEALTH SYSTEM
SCH130002-00 St. Luke's Magic Valley Regional Medical Center, LTD
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Covered Entity Details
Entity Name
St. Luke's Magic Valley Regional Medical Center, LTD
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH130002-00
Entity Address
801 Pole Line Rd.West
Twin Falls, ID 83301
Medicare Provider Number
130002
Participating Start Date
7/1/2013
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
ST LUKE'S HEALTH SYSTEM
Pharmacy Address
SPECIALTY PHARMACY
11801 W EXECUTIVE DR
BOISE, ID 83713
Pharmacy Comments
Contract Details
Approval Date
4/15/2022
Contract Begin Date
5/17/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
St. Luke's Health System, LTD
Tyler Hemsley, Director Pharmacy
(208) 706-9807
Signed By Date
4/15/2022
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