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Walgreens #21435
CAH131326-00 IHC Health Services Inc. DBA Intermountain Health Cassia Regional Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Cassia Regional Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131326-00
Entity Address
1501 Hiland Avenue
Burley, ID 83318
Medicare Provider Number
131326
Participating Start Date
4/1/2013
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
Walgreens #21435
Pharmacy Address
Walgreens Central Fill #21435
6306 S Airport Rd
West Jordan, UT 84084-5601
Pharmacy Comments
Contract Details
Approval Date
10/18/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diego Ortiz-Filinich, Finance Director
(954) 937-9479
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/18/2023
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