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IHC HEALTH SERVICES, INC.
DSH270017 St. James Healthcare dba Intermountain Health St. James Hospital
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Covered Entity Details
Entity Name
St. James Healthcare dba Intermountain Health St. James Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH270017
Entity Address
400 SOUTH CLARK STREET
BUTTE, MT 59701
Medicare Provider Number
270017
Participating Start Date
4/1/2023
Last Recertification Date
8/19/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
IHC HEALTH SERVICES, INC.
Pharmacy Address
DBA: INTERMOUNTAIN SPECIALTY PHARMACY
4393 RIVERBOAT RD SUITE 101
TAYLORSVILLE, UT 84123
Pharmacy Comments
Contract Details
Approval Date
10/19/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/24/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Pam Palagi, VP Financial Services
(406) 723-2414
Contract Pharmacy Representative
Intermountain Healthcare
Carrie Dunford, Chief Pharmacy Officer
(801) 284-1004
Signed By Date
10/19/2023
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