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IHC HEALTH SERVICES, INC.
DSH460004 IHC Health Services Inc. DBA Intermountain Health McKay-Dee Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health McKay-Dee Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460004
Entity Address
4401 HARRISON BLVD
OGDEN, UT 84403
Medicare Provider Number
460004
Participating Start Date
6/15/2020
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
IHC HEALTH SERVICES, INC.
Pharmacy Address
DBA: INTERMOUNTAIN HOME DELIVERY PHARMAC
DBA: INTERMOUNTAIN SPECIALTY PHARMACY
7268 S BINGHAM JUNCTION BLVD STE B1
MIDVALE, UT 84047
Pharmacy Comments
Contract Details
Approval Date
10/15/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Trever Porter, Finance Dir-MK
(801) 387-3767
Contract Pharmacy Representative
Intermountain Healthcare
Sabrina Cole, Executive Operations Director, System Pharmacy Services
(801) 284-1002
Signed By Date
10/15/2020
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