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SMITH'S PHARMACY
DSH460007 IHC Health Services Inc. DBA Intermountain Health Cedar City Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Cedar City Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460007
Entity Address
1303 NORTH MAIN ST
CEDAR CITY, UT 84721
Medicare Provider Number
460007
Participating Start Date
7/1/2020
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
SMITH'S PHARMACY
Pharmacy Address
SMITH'S FOOD & DRUG #42
633 S. MAIN
CEDAR CITY, UT 84720
Pharmacy Comments
Contract Details
Approval Date
4/13/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Craig Mills, Chief Financial Officer
(801) 662-6277
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/13/2019
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