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ST LUKE'S MERIDIAN MEDICAL
CAH131312-00 ST. LUKE'S MCCALL, LTD
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Covered Entity Details
Entity Name
ST. LUKE'S MCCALL, LTD
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131312-00
Entity Address
1000 State Street
MCCALL, ID 83638
Medicare Provider Number
131312
Participating Start Date
1/1/2013
Last Recertification Date
8/28/2024
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
10/10/2022
Contract Begin Date
11/1/2022
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 Nampa Medical Center, LTD
Steven Nadler, Pharmacy Outpatient Director
(208) 381-4354
Signed By Date
10/10/2022
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