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ST. LUKE'S NAMPA MEDICAL CENTER
DSH130006 ST LUKES REGIONAL MEDICAL CENTER, LTD.
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Covered Entity Details
Entity Name
ST LUKES REGIONAL MEDICAL CENTER, LTD.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH130006
Entity Address
190 EAST BANNOCK
BOISE, ID 83712
Medicare Provider Number
130006
Participating Start Date
7/1/2004
Last Recertification Date
8/29/2024
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
4/16/2018
Contract Begin Date
7/1/2018
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
4/16/2018
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