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UTAH CVS PHARMACY, L.L.C.
DSH460001 IHC Health Services, Inc. DBA: INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL
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Covered Entity Details
Entity Name
IHC Health Services, Inc. DBA: INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460001
Entity Address
1034 NORTH 500 WEST
PROVO, UT 84604
Medicare Provider Number
460001
Participating Start Date
10/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
UTAH CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16936
608 W MAIN ST
AMERICAN FORK, UT 84003
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/19/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kerry Gillespie, CFO-Specialty Based Care
(801) 442-2459
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/10/2019
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