Covered Entity Details

DSH500064K HARBORVIEW MEDICAL CENTER (Terminated) - information as of 5/25/2025 1:13:36 AM

Main Details

Name

HARBORVIEW MEDICAL CENTER

Subdivision Name

STD Chlamydia Program

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500064K

Medicare Provider Number

500064

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

7/10/2013

Participating Start Date

10/1/2013

Participating Approval Date

9/10/2013

Last Recertification Date

8/11/2014

Termination Date
Termination Reason

7/1/2015
Site closure

Contacts

Authorizing Official

UW Medicine
MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362

Primary Contact

Donald L. Bomgaars, Director of Pharmacy Services, Supply Chain Management & Contracts, UW Medicine
(206) 598-6055

Addresses

Street Address

908 Jefferson
Seattle, WA 98104

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
WA	1001277
		1053359729

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH500064A	Child	DSH	HARBORVIEW MEDICAL CENTER	Pioneer Sq Neighborhood Clinic	206 3rd Avenue South	Seattle	WA	Active
DSH500064AA	Child	DSH	HARBORVIEW MEDICAL CENTER	Specialty Clinics 7MB	410 9th Avenue	Seattle	WA	Terminated
DSH500064AB	Child	DSH	HARBORVIEW MEDICAL CENTER	Vascular Lab	908 Jefferson St	Seattle	WA	Active
DSH500064AC	Child	DSH	HARBORVIEW MEDICAL CENTER	Sleep Disorders	401 Broadway	Seattle	WA	Active
DSH500064AD	Child	DSH	HARBORVIEW MEDICAL CENTER	HMHS PSYCHOTHERAPY CLINIC	401 Broadway	Seattle	WA	Active
DSH500064AE	Child	DSH	HARBORVIEW MEDICAL CENTER	HMHS Gero Psych Clinic	401 Broadway	Seattle	WA	Active
DSH500064AF	Child	DSH	HARBORVIEW MEDICAL CENTER	Rehab Medicine Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064AG	Child	DSH	HARBORVIEW MEDICAL CENTER	Acute PT/OT/Speech	410 9th Avenue	Seattle	WA	Terminated
DSH500064AH	Child	DSH	HARBORVIEW MEDICAL CENTER	Rehab OP Ortho OT PT	908 Jefferson St	Seattle	WA	Active
DSH500064AJ	Child	DSH	HARBORVIEW MEDICAL CENTER	Ear Nose Throat Clinic	908 Jefferson	Seattle	WA	Terminated
DSH500064AK	Child	DSH	HARBORVIEW MEDICAL CENTER	HMC Prosthetic & Orthotic Service	501 Eastlake Ave E.	Seattle	WA	Active
DSH500064AL	Child	DSH	HARBORVIEW MEDICAL CENTER	HCSAT Medicine Clinic	401 Broadway	Seattle	WA	Terminated
DSH500064AM	Child	DSH	HARBORVIEW MEDICAL CENTER	HCSAT Medicine Clinic	401 Broadway	Seattle	WA	Active
DSH500064AN	Child	DSH	HARBORVIEW MEDICAL CENTER	Ambulatory Proc Spec Unit	410 9th Avenue	Seattle	WA	Active
DSH500064AP	Child	DSH	HARBORVIEW MEDICAL CENTER	HCSAT Counseling Cln	401 Broadway	Seattle	WA	Active
DSH500064AQ	Child	DSH	HARBORVIEW MEDICAL CENTER	Children's Response Center	1401 E. Jefferson	Seattle	WA	Terminated
DSH500064AR	Child	DSH	HARBORVIEW MEDICAL CENTER	Comp OP Rehab Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064AS	Child	DSH	HARBORVIEW MEDICAL CENTER	Neurosciences Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064AT	Child	DSH	HARBORVIEW MEDICAL CENTER	Sleep Medicine Clinic	401 Broadway St.	Seattle	WA	Active
DSH500064AU	Child	DSH	HARBORVIEW MEDICAL CENTER	NORM MALE - Neurology Clinic	908 Jefferson St	SEATTLE	WA	Active
DSH500064AV	Child	DSH	HARBORVIEW MEDICAL CENTER	NORM MALE - Hepatitis and Liver Clinic	908 Jefferson St	SEATTLE	WA	Active
DSH500064AW	Child	DSH	HARBORVIEW MEDICAL CENTER	NINTH & J - Stroke Clinic	908 JEFFERSON ST	SEATTLE	WA	Active
DSH500064AX	Child	DSH	HARBORVIEW MEDICAL CENTER	GI CLINIC	908 Jefferson St	Seattle	WA	Active
DSH500064AY	Child	DSH	HARBORVIEW MEDICAL CENTER	HEMATOLOGY CLINIC	908 Jefferson St	Seattle	WA	Active
DSH500064AZ	Child	DSH	HARBORVIEW MEDICAL CENTER	General Surgery Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064B	Child	DSH	HARBORVIEW MEDICAL CENTER	Foot, Ankle, and Podiatry Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064BA	Child	DSH	HARBORVIEW MEDICAL CENTER	ADULT UROLOGY CLINIC	908 Jefferson St	Seattle	WA	Active
DSH500064BB	Child	DSH	HARBORVIEW MEDICAL CENTER	CHEST CLINIC	908 Jefferson St	Seattle	WA	Active
DSH500064BC	Child	DSH	HARBORVIEW MEDICAL CENTER	RENAL CLINIC	908 Jefferson St	Seattle	WA	Active
DSH500064BD	Child	DSH	HARBORVIEW MEDICAL CENTER	CHRONIC FATIGUE CLINIC	410 9th Avenue	Seattle	WA	Terminated
DSH500064BE	Child	DSH	HARBORVIEW MEDICAL CENTER	ENDOSCOPY	410 9th Avenue	Seattle	WA	Active
DSH500064BF	Child	DSH	HARBORVIEW MEDICAL CENTER	EYE INSTITUTE OR	908 Jefferson St	Seattle	WA	Active
DSH500064BG	Child	DSH	HARBORVIEW MEDICAL CENTER	HMC RADIOLOGY DIAGNOSI - Radiology	908 Jefferson St.	Seattle	WA	Active
DSH500064BH	Child	DSH	HARBORVIEW MEDICAL CENTER	HMC NUCLEAR MEDICINE - Radiology-Diagnostics	908 Jefferson St.	Seattle	WA	Terminated
DSH500064BJ	Child	DSH	HARBORVIEW MEDICAL CENTER	MRI MAGNETIC RESONANCE IMAGING - MRI	908 Jefferson St.	Seattle	WA	Active
DSH500064BK	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - Computed Tomography H	908 Jefferson St.	Seattle	WA	Active
DSH500064BL	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - MOD MAX Attendance Incentives Grant	908 Jefferson St.	Seattle	WA	Active
DSH500064BM	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - Adult Medicine Clinic	319 Terry Ave	Seattle	WA	Active
DSH500064BN	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - Operating Room H	410 9th Ave	Seattle	WA	Terminated
DSH500064BP	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - Recovery Room	410 9th Ave	Seattle	WA	Active
DSH500064BQ	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - CVD19 Vaccine DIST H	319 Terry Ave	Seattle	WA	Terminated
DSH500064BR	Child	DSH	HARBORVIEW MEDICAL CENTER	HMC - PSQ MED RESPITE EXP	800 Jefferson St.	Seattle	WA	Active
DSH500064BS	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - PSQ 1811 EASTLAKE	206 3rd Ave S	Seattle	WA	Terminated
DSH500064BT	Child	DSH	HARBORVIEW MEDICAL CENTER	HMC - RETINA CENTER	750 Republican St. Building F	Seattle	WA	Terminated
DSH500064BU	Child	DSH	HARBORVIEW MEDICAL CENTER	HMC - PSQ SAM	206 3rd Ave S	Seattle	WA	Terminated
DSH500064BV	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - Familiar Aces ICMT	401 Broadway	Seattle	WA	Active
DSH500064BW	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - Hobson Place	2120 S. Plum St.	Seattle	WA	Active
DSH500064BX	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Medical Center - HMHS Housing & Employment	401 Broadway	Seattle	WA	Active
DSH500064BY	Child	DSH	HARBORVIEW MEDICAL CENTER	WA-STR MAT - OBOT RESPONSE CLINIC	401 Broadway St	Seattle	WA	Active
DSH500064BZ	Child	DSH	HARBORVIEW MEDICAL CENTER	CARDIOLOGY CLINIC H - H HEART INSTITUTE	908 Jefferson St	Seattle	WA	Active
DSH500064C	Child	DSH	HARBORVIEW MEDICAL CENTER	Spine Center	908 Jefferson St	SEATTLE	WA	Active
DSH500064CA	Child	DSH	HARBORVIEW MEDICAL CENTER	PULMONARY FUNCTION H - H PULMONARY FUNCTION LAB	908 Jefferson St	Seattle	WA	Active
DSH500064CB	Child	DSH	HARBORVIEW MEDICAL CENTER	Cardiology - Echo Lab	908 Jefferson St	Seattle	WA	Active
DSH500064CC	Child	DSH	HARBORVIEW MEDICAL CENTER	Harborview Diabetes Endocrinology Clinic - Harborview Diabetes Endocrinology Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064CD	Child	DSH	HARBORVIEW MEDICAL CENTER	Prosthetic/Orthotic Service - H Prosthetic & Orthotic Maleng	908 Jefferson St.	Seattle	WA	Active
DSH500064CE	Child	DSH	HARBORVIEW MEDICAL CENTER	Spine Center PSSSP - Spine Sports Med PSSP	908 Jefferson St,	Seattle	WA	Active
DSH500064CF	Child	DSH	HARBORVIEW MEDICAL CENTER	WA-STR MAT - OBOT HOBSON - OBOT Hobson	2120 South Plum St.	Seattle	WA	Active
DSH500064CG	Child	DSH	HARBORVIEW MEDICAL CENTER	WA-STR MAT - OBOT PSQ - OBOT Pioneer Square	206 3rd Ave S	Seattle	WA	Active
DSH500064D	Child	DSH	HARBORVIEW MEDICAL CENTER	Thoracic Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064E	Child	DSH	HARBORVIEW MEDICAL CENTER	Eye Institute	908 Jefferson St	Seattle	WA	Active
DSH500064F	Child	DSH	HARBORVIEW MEDICAL CENTER	Family Medicine Clinic	401 Broadway	Seattle	WA	Active
DSH500064G	Child	DSH	HARBORVIEW MEDICAL CENTER	HMHS Addictions Clinic	401 Broadway	Seattle	WA	Terminated
DSH500064H	Child	DSH	HARBORVIEW MEDICAL CENTER	Addictions Clinic	401 Broadway	Seattle	WA	Active
DSH500064J	Child	DSH	HARBORVIEW MEDICAL CENTER	STD Clinic	908 Jefferson	Seattle	WA	Terminated
DSH500064K	Child	DSH	HARBORVIEW MEDICAL CENTER	STD Chlamydia Program	908 Jefferson	Seattle	WA	Terminated
DSH500064L	Child	DSH	HARBORVIEW MEDICAL CENTER	STD Syphilis Elimination	908 Jefferson	Seattle	WA	Terminated
DSH500064M	Child	DSH	HARBORVIEW MEDICAL CENTER	STD Partner Project	908 Jefferson	Seattle	WA	Terminated
DSH500064N	Child	DSH	HARBORVIEW MEDICAL CENTER	Mental Health Intake & Brief Intervention Services Clinic	401 Broadway	Seattle	WA	Active
DSH500064P	Child	DSH	HARBORVIEW MEDICAL CENTER	Vascular Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064Q	Child	DSH	HARBORVIEW MEDICAL CENTER	Pioneer Square SAMHSA	206 3rd Avenue South	Seattle	WA	Terminated
DSH500064R	Child	DSH	HARBORVIEW MEDICAL CENTER	Pioneer Square Heathcare for Homeless	206 3rd Avenue South	Seattle	WA	Terminated
DSH500064S	Child	DSH	HARBORVIEW MEDICAL CENTER	Pioneer Square HSP Access Program	206 3rd Avenue South	Seattle	WA	Terminated
DSH500064T	Child	DSH	HARBORVIEW MEDICAL CENTER	Pioneer Square Respite Program	Jefferson Terrace	Seattle	WA	Terminated
DSH500064U	Child	DSH	HARBORVIEW MEDICAL CENTER	HMHS Mental Health Recovery Svcs	401 Broadway	Seattle	WA	Active
DSH500064V	Child	DSH	HARBORVIEW MEDICAL CENTER	Pioneer Square 3rd Avenue Clinic	2028 3rd Ave	Seattle	WA	Active
DSH500064W	Child	DSH	HARBORVIEW MEDICAL CENTER	Otolaryngology Specialty Clinic	908 Jefferson	Seattle	WA	Terminated
DSH500064X	Child	DSH	HARBORVIEW MEDICAL CENTER	Hand Institute Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064Y	Child	DSH	HARBORVIEW MEDICAL CENTER	Palliative Medicine Clinic	908 Jefferson St	Seattle	WA	Active
DSH500064Z	Child	DSH	HARBORVIEW MEDICAL CENTER	Pioneer Square 2nd Avenue Clinic	2124 4th Ave	Seattle	WA	Terminated

History

Section	Field	Action	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	BROOM, MAUREEN Enterprise Finance Officer 2065985362	BROOM, MAUREEN Enterprise Finance Officer UW Medicine 2065985362	9/21/2017 11:53 AM
Contacts	Authorizing Official	Update	Mitchell, Lori CFO, UW Medicine 2066169886	BROOM, MAUREEN Enterprise Finance Officer 2065985362	9/11/2017 3:29 PM
Contacts	Authorizing Official	Insert		Mitchell, Lori CFO, UW Medicine 2066169886	8/9/2017 2:15 PM
Contacts	Signed By	Insert		Mitchell, Lori CFO, UW Medicine 2066169886	8/9/2017 2:15 PM
Contacts	Primary Contact	Insert		Bomgaars, Donald L. Director of Pharmacy Services, Supply Chain Management & Contracts, UW Medicine 2065986055	7/17/2017 3:24 PM
Addresses	Main Address	Insert		908 Jefferson Seattle, WA 98104	4/21/2015 2:31 PM
Medicaid Billing	Medicaid: Is Primary	Insert		False	4/21/2015 2:30 PM
Medicaid Billing	Medicaid: Number	Insert		1001277	4/21/2015 2:30 PM
Medicaid Billing	Medicaid: State	Insert		WA	4/21/2015 2:30 PM
Medicaid Billing	NPI: Number	Insert		1053359729	4/21/2015 2:30 PM
Dates	Last Date That 340B Drugs Purchased	Update		6/30/2014 12:00:00 AM	4/6/2015 2:30 PM
Details	State	Update	Active	Terminated	4/6/2015 2:30 PM
Terminations	Termination Comments	Update		This child site was determined to be ineligible due to the clarification from the OPA in spring of 2014, in regards to using the PECOS system to validate the trial balances for reimbursable line items on the Medicare Cost Report. Since these child sites did not have any hospital outpatient charges reported, we have internally deemed this child site to be ineligible to be compliant with the guidance provided by the OPA.	4/6/2015 2:30 PM
Terminations	Termination Date	Update		7/1/2015 12:00:00 AM	4/6/2015 2:30 PM
Terminations	Termination Effective Date	Update		7/1/2014 12:00:00 AM	4/6/2015 2:30 PM
Terminations	Termination Reason	Update		Site closure	4/6/2015 2:30 PM
Details	Last Recertification Date	Update		8/11/2014 12:00:00 AM	8/11/2014 10:04 AM
Dates	Participating Approval Date	Update		9/10/2013 12:00:00 AM	9/10/2013 7:14 PM
Details	State	Update	Pending	Active	9/10/2013 7:14 PM
Dates	Start Date	Update		10/1/2013 12:00:00 AM	9/10/2013 7:14 PM
Details	340B ID	Update	OUTPATIENT_ONLINE_REG	DSH500064K	8/20/2013 1:21 PM
Details	Last Recertification Date	Insert			7/10/2013 2:44 PM
Details	Grant Number	Insert			7/10/2013 2:44 PM
Details	340B ID	Insert		OUTPATIENT_ONLINE_REG	7/10/2013 2:44 PM
Details	Is Authorizing Official EHB Data	Insert			7/10/2013 2:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert			7/10/2013 2:44 PM
Details	Medicare Provider Number	Insert		500064	7/10/2013 2:44 PM
Details	Entity Name	Insert		HARBORVIEW MEDICAL CENTER	7/10/2013 2:44 PM
Details	Program Code	Insert		DSH	7/10/2013 2:44 PM
Details	Entity Subname	Insert		STD Chlamydia Program	7/10/2013 2:44 PM
Dates	Participating Approval Date	Insert			7/10/2013 2:44 PM
Details	State	Insert		Pending	7/10/2013 2:44 PM
Dates	Registration Date	Insert		7/10/2013 12:00:00 AM	7/10/2013 2:44 PM
Dates	Signed By Date	Insert		7/10/2013 12:00:00 AM	7/10/2013 2:44 PM
Dates	Start Date	Insert			7/10/2013 2:44 PM
Terminations	Termination Comments	Insert			7/10/2013 2:44 PM
Terminations	Termination Date	Insert			7/10/2013 2:44 PM
Terminations	Termination Effective Date	Insert			7/10/2013 2:44 PM
Terminations	Termination Reason	Insert			7/10/2013 2:44 PM