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IHC HEALTH SERVICES INC.
CAH461303-00 IHC Health Services INC dba INTERMOUNTAIN HEALTH SANPETE VALLEY HOSPITAL
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Covered Entity Details
Entity Name
IHC Health Services INC dba INTERMOUNTAIN HEALTH SANPETE VALLEY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH461303-00
Entity Address
1100 SOUTH MEDICAL DRIVE
MT. PLEASANT, UT 84647
Medicare Provider Number
461303
Participating Start Date
10/1/2014
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
IHC HEALTH SERVICES INC.
Pharmacy Address
DBA INTERMOUNTAIN PHARMACY #140
159 NORTH MAIN
MANTI, UT 84642-1757
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/23/2021
Pharmacy closed
Contacts
Covered Entity Signing Official
Aaron Wood, CEO/Administrator-Sanpete
(435) 462-4123
Contract Pharmacy Representative
Intermountain Healthcare
Sabrina Cole, Executive Operations Director, System Pharmacy Services
(801) 284-1002
Signed By Date
1/15/2015
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