340B Drug Pricing Program Database
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DSH460004A MCKAY-DEE HOSPITAL (Terminated)
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Main Details
Name
MCKAY-DEE HOSPITAL
Subdivision Name
Summit Day Treatment
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460004A
Medicare Provider Number
460004
Outpatient Facility Provider Number
460004
Additional Details
Current Program Status
Terminated
Registration Date
5/29/2020
Participating Start Date
6/15/2020
Participating Approval Date
6/5/2020
Last Recertification Date
8/26/2020
Termination Date
Termination Reason
10/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
Intermountain Healthcare
Trever Porter, Finance Dir-MK
(801) 387-3767
Primary Contact
Intermountain Healthcare
Charles B. Stubbs, 340B Pharmacist
(801) 284-1113
Addresses
Street Address
4387 Harrison Blvd. Suite C4
Ogden, UT 84403
Billing Address
McKay-Dee Hospital Center
4401 Harrison Blvd
Ogden, UT 84403
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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