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DSH460004E MCKAY-DEE HOSPITAL (Terminated)
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Main Details
Name
MCKAY-DEE HOSPITAL
Subdivision Name
Anti-Coagulation Clinic - Anti-Coagulation Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460004E
Medicare Provider Number
460004
Outpatient Facility Provider Number
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
8/25/2021
Termination Date
Termination Reason
10/1/2022
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
4421 Harrison Blvd.
Suite A-12
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 4/1/18, Terminated 7/1/2018. Reinstated 6/15/2020.
06/11/2020
May 2025
May 2025
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