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IHC HEALTH SERVICES, INC.
CAH131313-00 Teton Valley Health Care, Inc. dba Teton Valley Hospital
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Covered Entity Details
Entity Name
Teton Valley Health Care, Inc. dba Teton Valley Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH131313-00
Entity Address
120 East Howard Avenue
Driggs, ID 83422
Medicare Provider Number
131313
Participating Start Date
7/1/2013
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
IHC HEALTH SERVICES, INC.
Pharmacy Address
DBA INTERMOUNTAIN HEALTH INFUSION PHARMA
11520 SOUTH REDWOOD ROAD
SOUTH JORDAN, UT 84095
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2024
Agreement registered in error
Contacts
Covered Entity Signing Official
Troy Christensen, CEO
(208) 354-6340
Contract Pharmacy Representative
Intermountain Homecare & Hospice
Alisa Thomas, Pharmacy Manager
(385) 887-5932
Signed By Date
7/15/2024
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