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UTAH CVS PHARMACY, L.L.C.
RRC460010-00 IHC Health Services Inc. dba INTERMOUNTAIN HEALTH INTERMOUNTAIN MEDICAL CENTER
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Covered Entity Details
Entity Name
IHC Health Services Inc. dba INTERMOUNTAIN HEALTH INTERMOUNTAIN MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC460010-00
Entity Address
5121 S COTTONWOOD ST
MURRAY, UT 84107
Medicare Provider Number
460010
Participating Start Date
6/8/2022
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
UTAH CVS PHARMACY, L.L.C.
Pharmacy Address
CVS PHARMACY # 16878
7025 S. PARK CENTRE DR
SALT LAKE CITY, UT 84121
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
8/16/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/18/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Royce Stephens, Finance Director
(801) 507-7948
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2022
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