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IHC HEALTH SERVICES INC
PED463301-00 IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH PRIMARY CHILDREN'S HOSPITAL
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Covered Entity Details
Entity Name
IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH PRIMARY CHILDREN'S HOSPITAL
Subdivision Name
Type
Children's Hospital
340B ID
PED463301-00
Entity Address
100 NORTH MARIO CAPECCHI DRIVE
SALT LAKE CITY, UT 84113
Medicare Provider Number
463301
Participating Start Date
1/1/2010
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
IHC HEALTH SERVICES INC
Pharmacy Address
DBA: INTERMOUNTAIN PHARMACY #138
100 N MARIO CAPECCHI DR
ATTN OUTPATIENT PHARMACY
SALT LAKE CITY, UT 84113
Pharmacy Comments
Contract Details
Approval Date
8/5/2020
Contract Begin Date
8/5/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sidney Norton, Finance AVP - Pediatrics
(801) 662-6277
Contract Pharmacy Representative
Intermountain Healthcare
Sabrina Cole, Executive Operations Director, System Pharmacy Services
(801) 284-1002
Signed By Date
8/5/2020
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