340B Drug Pricing Program Database
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PED463301-09 IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH PRIMARY CHILDREN'S HOSPITAL (Active)
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Main Details
Name
IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH PRIMARY CHILDREN'S HOSPITAL
Subdivision Name
Dialysis Clinic
Type
Children's Hospital
Rural
No
340B ID
PED463301-09
Medicare Provider Number
463301
Outpatient Facility Provider Number
462320
Additional Details
Current Program Status
Active
Registration Date
10/6/2016
Participating Start Date
1/1/2017
Participating Approval Date
10/21/2016
Last Recertification Date
8/19/2024
Contacts
Authorizing Official
Primary Children's Hospital
Sidney Norton, Finance AVP - Pediatrics
(801) 662-6277
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
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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May 2025
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