340B Drug Pricing Program Database
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DSH460006C IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH LDS HOSPITAL (Active)
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Main Details
Name
IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH LDS HOSPITAL
Subdivision Name
Infusion Center - Murray Campus
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460006C
Medicare Provider Number
460006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/30/2024
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Intermountain Healthcare
Mike DeMotte, Finance Director
(801) 408-2087
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
5131 South Cottonwood Street, Suite 300
Murray, UT 84107
Billing Address
IHC Health Services Inc. dba LDS HOSPITAL
PO Box 30184
Salt Lake City, UT 84130
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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