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IHC HEALTH SERVICES, INC.
SCH130002-00 St. Luke's Magic Valley Regional Medical Center, LTD
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Covered Entity Details
Entity Name
St. Luke's Magic Valley Regional Medical Center, LTD
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH130002-00
Entity Address
801 Pole Line Rd.West
Twin Falls, ID 83301
Medicare Provider Number
130002
Participating Start Date
7/1/2013
Last Recertification Date
8/14/2024
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
4/11/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Peter DiDio, Vice President, Controller
(208) 381-1251
Contract Pharmacy Representative
Marc Holley, Pharmacy Operations Director
(801) 284-1006
Signed By Date
4/11/2017
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