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ACCREDO HEALTH GROUP, INC.
DSH460006 IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH LDS HOSPITAL
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Covered Entity Details
Entity Name
IHC HEALTH SERVICES, INC. INTERMOUNTAIN HEALTH LDS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460006
Entity Address
8TH AVENUE AND C STREET.
SALT LAKE CITY, UT 84143
Medicare Provider Number
460006
Participating Start Date
5/15/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
5/15/2023
Contract Begin Date
5/15/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mike DeMotte, Finance Director
(801) 408-2087
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
5/4/2023
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