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WALGREEN CO.
CAH461333-00 IHC Health Services Inc. DBA Intermountain Health Garfield Memorial Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Garfield Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461333-00
Entity Address
200 North 400 East
Panguitch, UT 84759
Medicare Provider Number
461333
Participating Start Date
7/1/2017
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16481
201 S 1300 E STE 101
SALT LAKE CITY, UT 84102
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/17/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alberto Vasquez, Administrator
(435) 676-1261
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2018
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