340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PED463301-33 IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH PRIMARY CHILDREN'S HOSPITAL (Active)
Print
Main Details
Name
IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH PRIMARY CHILDREN'S HOSPITAL
Subdivision Name
Pediatric Clinics - Pediatric Cystic Fibrosis
Type
Children's Hospital
Rural
No
340B ID
PED463301-33
Medicare Provider Number
463301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/24/2024
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Primary Children's Hospital
Sidney Norton, Finance AVP - Pediatrics
(801) 662-6277
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
2250 N. Miller Campus Drive, Level 2, Pod 22
Lehi, UT 84043
Billing Address
IHC HEALTH SERVICES INC. DBA PRIMARY CHILDREN'S HOSPITAL
100 NORTH MARIO CAPECCHI DRIVE
SALT LAKE CITY, UT 84113
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session