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WALGREENS SPECIALTY PHARMACY, LLC
CAH461301-00 IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461301-00
Entity Address
674 SOUTH HIGHWAY 99
FILLMORE, UT 84631
Medicare Provider Number
461301
Participating Start Date
10/1/2014
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
WALGREENS SPECIALTY PHARMACY, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #15438
41460 HAGGERTY CIR S
CANTON, MI 48188
Pharmacy Comments
Contract Details
Approval Date
10/11/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/7/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lenny Lyons, Administrator--Delta Community Medical Center
(435) 864-1510
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/11/2018
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