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DSH460004F MCKAY-DEE HOSPITAL CENTER (Terminated)
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Main Details
Name
MCKAY-DEE HOSPITAL CENTER
Subdivision Name
Physical Therapy Complex - OP - Stewart Rehabilitation
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460004F
Medicare Provider Number
460004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/2/2018
Last Recertification Date
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
Intermountain Healthcare
Kevin Jones, 340B Program Director
(801) 284-1023
Addresses
Street Address
3903 Harrison Blvd
Suite 400
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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