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DSH460004C MCKAY-DEE HOSPITAL CENTER (Terminated)
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Main Details
Name
MCKAY-DEE HOSPITAL CENTER
Subdivision Name
Physical Therapy-Layton
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460004C
Medicare Provider Number
460004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/17/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/15/2017
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
Lacy Gerace, 340B Specialist
(801) 387-6007
Addresses
Street Address
2075 North 1200 West
Layton, UT 84041-1616
Billing Address
McKay Dee Hospital
4401 Harrison Blvd
Ogden, UT 84403-3195
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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