340B Drug Pricing Program Database
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DSH460001 IHC Health Services, Inc. DBA: INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL (Active)
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Main Details
Name
IHC Health Services, Inc. DBA: INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH460001
Medicare Provider Number
460001
Additional Details
Current Program Status
Active
Registration Date
9/6/2006
Participating Start Date
10/1/2006
Participating Approval Date
9/6/2006
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Utah Valley Hospital
Amy Valenzuela, Finance Director
(801) 357-7049
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
1034 NORTH 500 WEST
PROVO, UT 84604
Billing Address
IHC Health Services, Inc. DBA: INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL
PO Box 30184
Salt Lake City, UT 84130
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/23/12 UPDATED ZIP (WAS 84605); 1/14/2011- DOC. RECD. TO CONFIRM ELIG. DSH PERCENTAGE; 12/30/2009 DOC. RECD. TO CONFIRM DSH ADJ.
03/23/2012
1/14/2011- DOC. RECD. TO CONFIRM ELIG. DSH PERCENTAGE; 12/30/2009 DOC. RECD. TO CONFIRM DSH ADJ.
11/09/2011
1/14/2011- DOC. RECD. TO CONFIRM ELIG. DSH PERCENTAGE; 12/30/2009 DOC. RECD. TO CONFIRM DSH ADJ.
12/30/2009
1/14/2011- DOC. RECD. TO CONFIRM ELIG. DSH PERCENTAGE; 12/30/2009 DOC. RECD. TO CONFIRM DSH ADJ.
12/30/2009
May 2025
May 2025
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