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SMITHS FOOD & DRUG CTRS
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
SMITHS FOOD & DRUG CTRS
Pharmacy Address
DBA SMITH'S PHARMACY #279
2434 NORTH 400 EAST
NORTH OGDEN, UT 84414
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
4/13/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/11/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Trever Porter, Finance Dir-MK
(801) 387-3767
Contract Pharmacy Representative
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/11/2022
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