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CYSTIC FIBROSIS SERVICES, LLC
DSH460007 IHC Health Services Inc. DBA Intermountain Health Cedar City Hospital
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Covered Entity Details
Entity Name
IHC Health Services Inc. DBA Intermountain Health Cedar City Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH460007
Entity Address
1303 NORTH MAIN ST
CEDAR CITY, UT 84721
Medicare Provider Number
460007
Participating Start Date
7/1/2020
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
CYSTIC FIBROSIS SERVICES, LLC
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #16280
10530 JOHN W ELLIOTT DR STE 200
FRISCO, TX 75033
Pharmacy Comments
Contract Details
Approval Date
7/4/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Steve Vance, Chief Financial Officer
(435) 251-2111
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/4/2017
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