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BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
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
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
Pharmacy Address
BIOPLUS SPECIALTY PHARMACY SERVICES, LLC
4740 VICTORY LN STE C
INDIANAPOLIS, IN 46203
Pharmacy Comments
Contract Details
Approval Date
10/1/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kate Fowler, Senior VP & CFO
(208) 381-8717
Contract Pharmacy Representative
BIOPLUS SPECIALTY PHARMACY
Bill Cook, Executive VP Sales and Business Development
(407) 388-5927 Ext: 4209
Signed By Date
10/1/2024
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