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IHC HEALTH SERVICES, INC.
DSH460001 IHC Health Services, Inc. DBA: INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL
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Covered Entity Details
Entity Name
IHC Health Services, Inc. DBA: INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460001
Entity Address
1034 NORTH 500 WEST
PROVO, UT 84604
Medicare Provider Number
460001
Participating Start Date
10/1/2006
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
IHC HEALTH SERVICES, INC.
Pharmacy Address
DBA INTERMOUNTAIN PHARMACY #816
505 W 400 N
OREM, UT 84057-1950
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/16/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Rod Lisonbee, CFO
(801) 357-7212
Contract Pharmacy Representative
Intermountain Healthcare
Sabrina Cole, Executive Operations Director, System Pharmacy Services
(801) 284-1002
Signed By Date
10/15/2014
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