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IHC HEALTH SERVICES, INC.
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
IHC HEALTH SERVICES, INC.
Pharmacy Address
DBA INTERMOUNTAIN PHARMACY #128
8TH AVE & C ST
ATTENTION OUTPATIENT PHARMACY
SALT LAKE CITY, UT 84143
Pharmacy Comments
Contract Details
Approval Date
12/16/2022
Contract Begin Date
12/20/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Royce Stephens, Finance Director
(801) 507-7948
Contract Pharmacy Representative
Intermountain Healthcare
Carrie Dunford, Chief Pharmacy Officer
(801) 284-1004
Signed By Date
12/16/2022
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