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DSH460004B MCKAY-DEE HOSPITAL CENTER (Terminated)
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Main Details
Name
MCKAY-DEE HOSPITAL CENTER
Subdivision Name
Layton Clinic Imaging Service
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460004B
Medicare Provider Number
460004
Outpatient Facility Provider Number
460004
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/4/2014
Last Recertification Date
11/10/2017
Termination Date
Termination Reason
7/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Intermountain Healthcare
Trever Porter, Finance Dir-MK
(801) 387-3767
Primary Contact
McKay-Dee Hospital , Intermountain Healthcare
Terrie Koehler, Region Director of Pharmacy
(801) 387-6002
Addresses
Street Address
2075 N 1200 West
Layton, UT 84041-1616
Billing Address
McKay-Dee Hospital Center
4401 Harrison Blvd
Ogden, UT 84403-3195
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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