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WAL-MART PHARMACY 10-4689
CAH461307-00 IHC Health Services Inc. DBA Intermountain Health Heber Valley Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Heber Valley Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461307-00
Entity Address
454 E Medical Way
Heber City, UT 84032
Medicare Provider Number
461307
Participating Start Date
4/1/2013
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-4689
Pharmacy Address
4689 CEDAR HILLS DR
CEDAR HILLS, UT 84062
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/22/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nathan Empey, Director of Finance
(801) 357-7049
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
1/15/2019
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