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SCH460026-01 IHC HEALTH SERVICES, INC. DBA: Intermountain Health SEVIER VALLEY HOSPITAL (Active)
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Main Details
Name
IHC HEALTH SERVICES, INC. DBA: Intermountain Health SEVIER VALLEY HOSPITAL
Subdivision Name
Sevier Valley Dialysis Center - Dialysis Clinic
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH460026-01
Medicare Provider Number
460026
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2019
Participating Start Date
7/1/2019
Participating Approval Date
5/8/2019
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Intermountain Healthcare
Vincent Donohue, Finance Director-Central UT Rural
(435) 983-0527
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
81 East 900 North
Richfield, UT 84701
Billing Address
Sevier Valley Hospital
1000 North Main St
Richfield, UT 84701
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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