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DSH460006A IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH LDS HOSPITAL (Active)
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Main Details
Name
IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH LDS HOSPITAL
Subdivision Name
LDS HOSPITAL OUTPATIENT PULMONARY CLINIC - PULMONARY CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH460006A
Medicare Provider Number
460006
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/3/2023
Participating Start Date
5/15/2023
Participating Approval Date
5/15/2023
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Intermountain Healthcare
Mike DeMotte, Finance Director
(801) 408-2087
Primary Contact
IHC Health Services, Inc.
Kevin Forbush, 340B Program Director
(385) 429-2887
Addresses
Street Address
324 10th Ave #170
SALT LAKE CITY, UT 84103
Billing Address
LDS HOSPITAL
8TH AVENUE AND C STREET
SALT LAKE CITY, UT 84103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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