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DSH460004 IHC Health Services Inc. DBA Intermountain Health McKay-Dee Hospital (Active)
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Main Details
Name
IHC Health Services Inc. DBA Intermountain Health McKay-Dee Hospital
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460004
Medicare Provider Number
460004
Additional Details
Current Program Status
Active
Registration Date
5/29/2020
Participating Start Date
6/15/2020
Participating Approval Date
6/5/2020
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Intermountain Healthcare
Trever Porter, Finance Dir-MK
(801) 387-3767
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
4401 HARRISON BLVD
OGDEN, UT 84403
Billing Address
IHC Health Services Inc. DBA Intermountain Health McKay-Dee Hospital
PO Box 30184
Salt Lake City, UT 84130
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated Starting 10/1/14, Terminated 7/1/2018. Reinstated 6/15/2020.
06/11/2020
May 2025
May 2025
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