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DSH460006D 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 Clinic - Alta View Campus - Bone Marrow Transplant - Infusion
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460006D
Medicare Provider Number
460006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/17/2024
Last Recertification Date
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
9450 S 1300 E Suite 450
Sandy, UT 84094
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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