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WALMART PHARMACY 10-5169
CAH461307-00 IHC Health Services Inc. DBA Intermountain Health Heber Valley Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Heber Valley Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461307-00
Entity Address
454 E Medical Way
Heber City, UT 84032
Medicare Provider Number
461307
Participating Start Date
4/1/2013
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
4/6/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/11/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Jennilyn Ferry, Finance Director
(435) 658-6709
Contract Pharmacy Representative
Wal-Mart
Julie Howard, 340B Program Manager
(479) 739-1973
Signed By Date
4/6/2023
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