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IHC HEALTH SERVICES, INC.
CAH461301-00 IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
IHC Health Services, INC. DBA: INTERMOUNTAIN HEALTH FILLMORE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461301-00
Entity Address
674 SOUTH HIGHWAY 99
FILLMORE, UT 84631
Medicare Provider Number
461301
Participating Start Date
10/1/2014
Last Recertification Date
8/20/2024
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
4/13/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kurt S Forsyth, Administrator
(801) 837-8704
Contract Pharmacy Representative
Intermountain Healthcare
Sabrina Cole, Executive Operations Director, System Pharmacy Services
(801) 284-1002
Signed By Date
4/13/2021
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