340B Drug Pricing Program Database
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PED463301-03 IHC HEALTH SERVICES INC. DBA PRIMARY CHILDREN'S HOSPITAL (Terminated)
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Main Details
Name
IHC HEALTH SERVICES INC. DBA PRIMARY CHILDREN'S HOSPITAL
Subdivision Name
Safe and Healthy Families
Type
Children's Hospital
Rural
No
340B ID
PED463301-03
Medicare Provider Number
463301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/25/2013
Last Recertification Date
8/30/2021
Termination Date
Termination Reason
1/1/2022
Business decision by the Covered Entity
Contacts
Authorizing Official
Primary Children's Hospital
Sidney Norton, Finance AVP - Pediatrics
(801) 662-6277
Primary Contact
Intermountain Healthcare
Charles B. Stubbs, 340B Pharmacist
(801) 284-1113
Addresses
Street Address
81 North Mario Cappechi Drive
Salt Lake City, UT 84113
Billing Address
Primary Children's Hospital
100 North Mario Cappechi Drive
Salt Lake City, UT 84113
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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