340B Drug Pricing Program Database
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CAH461301-00 IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL (Active)
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Main Details
Name
IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH461301-00
Medicare Provider Number
461301
Additional Details
Current Program Status
Active
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/8/2014
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
Intermountain
Kurt S Forsyth, Administrator
(801) 837-8704
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
674 SOUTH HIGHWAY 99
FILLMORE, UT 84631
Billing Address
IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL
PO Box 30184
Salt Lake City, UT 84130
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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