340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PED463301-12 IHC HEALTH SERVICES INC. DBA PRIMARY CHILDREN'S HOSPITAL (Terminated)
Print
Main Details
Name
IHC HEALTH SERVICES INC. DBA PRIMARY CHILDREN'S HOSPITAL
Subdivision Name
Primary Children's Outpatient Imaging Services - Riverton - Magnetic Resonance Imaging (MRI)
Type
Children's Hospital
Rural
No
340B ID
PED463301-12
Medicare Provider Number
463301
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/15/2019
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
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
3773 West 12600 South
Riverton, UT 84065
Billing Address
Primary Children's Hospital
100 Mario Capecchi Drive
Salt Lake City, UT 84113
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
0
to
0
of
0
Page:
of 1
Go
Page size:
Change
No records to display.
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session