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SMITH'S FOOD & DRUG CTR
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
SMITH'S FOOD & DRUG CTR
Pharmacy Address
SMITH'S FOOD & DRUG #144
45 SOUTH STATE
OREM, UT 84057
Pharmacy Comments
Contract Details
Approval Date
12/14/2021
Contract Begin Date
12/15/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Nathan Empey, Director of Finance
(801) 357-7049
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
12/14/2021
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