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WAL-MART PHARMACY 10-5168
SCH460026-00 IHC HEALTH SERVICES, INC. DBA: Intermountain Health SEVIER VALLEY HOSPITAL
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Covered Entity Details
Entity Name
IHC HEALTH SERVICES, INC. DBA: Intermountain Health SEVIER VALLEY HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH460026-00
Entity Address
1000 NORTH MAIN ST
RICHFIELD, UT 84701
Medicare Provider Number
460026
Participating Start Date
7/1/2019
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5168
Pharmacy Address
10 EAST 1300 SOUTH
RICHFIELD, UT 84701
Pharmacy Comments
Contract Details
Approval Date
4/14/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/27/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vincent Donohue, Finance Director-Central UT Rural
(435) 983-0527
Contract Pharmacy Representative
Walmart
Julie Howard, 340b Program Manager
(479) 739-1973 Ext: 4792771498
Signed By Date
4/14/2021
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