340B Drug Pricing Program Database
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RRC460010-00 IHC Health Services Inc. dba INTERMOUNTAIN HEALTH INTERMOUNTAIN MEDICAL CENTER (Active)
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Main Details
Name
IHC Health Services Inc. dba INTERMOUNTAIN HEALTH INTERMOUNTAIN MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC460010-00
Medicare Provider Number
460010
Additional Details
Current Program Status
Active
Registration Date
6/3/2022
Participating Start Date
6/8/2022
Participating Approval Date
6/8/2022
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Intermountain Healthcare
Nathan Empey, Director of Finance
(801) 357-7049
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
5121 S COTTONWOOD ST
MURRAY, UT 84107
Billing Address
IHC Health Services Inc. dba INTERMOUNTAIN HEALTH INTERMOUNTAIN MEDICAL CENTER
PO Box 30184
Salt Lake City, UT 84130
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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