340B Drug Pricing Program Database
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RRC460015-00 LOGAN REGIONAL HOSPITAL (Approved)
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Main Details
Name
LOGAN REGIONAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
Rural
Yes
340B ID
RRC460015-00
Medicare Provider Number
460015
Additional Details
Current Program Status
Approved
Registration Date
4/10/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/23/2025
Last Recertification Date
Contacts
Authorizing Official
Intermountain Health - Logan Regional Hospital
Diego Ortiz-Filinich, Finance Director
(954) 937-9479
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
1400 NORTH 500 EAST
LOGAN, UT 84341
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/25/2023, terminated 7/1/2024. Reinstated 7/1/2025.
04/16/2025
April 2025
April 2025
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