Covered Entity Details

DSH500027AY SWEDISH MEDICAL CENTER (Active) - information as of 5/13/2025 10:58:23 PM

Main Details

Name

SWEDISH MEDICAL CENTER

Subdivision Name

Swedish Orthopedic Institute, Orthopedic Services/Observation

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH500027AY

Medicare Provider Number

500027

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/14/2015

Participating Start Date

7/1/2015

Participating Approval Date

5/22/2015

Last Recertification Date

8/26/2024

Contacts

Authorizing Official

Swedish Medical Center First Hill
Eric M Delgado, Chief Financial Officer
(562) 243-3861

Primary Contact

Providence/Swedish
Melisa G Lea, 340B Program Manager
(206) 756-0546

Addresses

Street Address

601 Broadway
Seattle, WA 98122

Billing Address

Providence St Joseph Health
PO BOX 31263
Salt Lake City, UT 84131

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
ID	1306992151	1306992151
AK	1006184	1306992151
OR	034280	1306992151
WA	3309200	1306992151
CA		1306992151
MT		1306992151

Shipping Addresses

Shipping Address 1

Swedish Medical Center- Receiving Dock
702 Minor Ave
Seattle, WA 98104

Shipping Address 2

Swedish Medical Center
747 Broadway
Seattle, WA 98122

Shipping Address 3

Safecor Health LLC
4060 Business Park Dr, Suite B
Columbus, OH 43204

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
DSH500027A	Child	DSH	SWEDISH MEDICAL CENTER	BALLARD CAMPUS	5300 Tallman Ave NW	SEATTLE	WA	Terminated
DSH500027AA	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Orthopedic Institute, Ambulatory Surgery	601 Broadway	Seattle	WA	Active
DSH500027AB	Child	DSH	SWEDISH MEDICAL CENTER	True Family Women's Cancer Center	1221 Madison St	Seattle	WA	Active
DSH500027AC	Child	DSH	SWEDISH MEDICAL CENTER	Center for Blood Disorders and Stem Cell Transplantation	1221 Madison St	Seattle	WA	Active
DSH500027AD	Child	DSH	SWEDISH MEDICAL CENTER	Imaging, Ballard / Ultrasound /21576700	5350 Tallman Ave NW	Seattle	WA	Active
DSH500027AE	Child	DSH	SWEDISH MEDICAL CENTER	Imaging, Ballard / CT Scanning	5350 Tallman Ave NW	Seattle	WA	Active
DSH500027AF	Child	DSH	SWEDISH MEDICAL CENTER	Outpatient Rehabilitation, Ballard/21577709	5300 Tallman Ave NW	Seattle	WA	Terminated
DSH500027AG	Child	DSH	SWEDISH MEDICAL CENTER	Imaging, Ballard / MRI /21576600	5350 Tallman Ave NW	Seattle	WA	Active
DSH500027AH	Child	DSH	SWEDISH MEDICAL CENTER	Ballard / Medical Imaging	5350 Tallman Ave NW	Seattle	WA	Active
DSH500027AJ	Child	DSH	SWEDISH MEDICAL CENTER	SCI Ballard, Radiation Treatment Center/21576420	5225 Tallman Ave NW	Seattle	WA	Terminated
DSH500027AK	Child	DSH	SWEDISH MEDICAL CENTER	SCI Ballard Medical Oncology	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027AL	Child	DSH	SWEDISH MEDICAL CENTER	SCI Medical Treatment Center, Ballard	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027AM	Child	DSH	SWEDISH MEDICAL CENTER	Ambulatory Surgery, Ballard	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027AN	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Emergency Room	5350 Tallman Ave NW	Seattle	WA	Active
DSH500027AP	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH CANCER INSTITUTE RADIATION	1221 MADISON STREET	SEATTLE	WA	Active
DSH500027AQ	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH CANCER INSTITUTE FIRST HILL MEDICAL ONCOLOGY	1221 MADISON STREET	SEATTLE	WA	Active
DSH500027AR	Child	DSH	SWEDISH MEDICAL CENTER	OUTPATIENT PHYSICAL THERAPY	1101 MADISON STREET	SEATTLE	WA	Terminated
DSH500027AS	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH CANCER INSTITUTE MEDICAL TREATMENT CTR	1221 MADISON STREET	SEATTLE	WA	Active
DSH500027AT	Child	DSH	SWEDISH MEDICAL CENTER	Anticoagulation & Pharmacotherapy Clinic, First Hill/21070800	601 Broadway	Seattle	WA	Active
DSH500027AU	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH CANCER INSTITUTE AT HIGHLINE	16233 SYLVESTER ROAD SW	BURIEN	WA	Terminated
DSH500027AV	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH PAIN AND HEADACHE CENTER/21070708	600 Broadway	SEATTLE	WA	Active
DSH500027AW	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Campus / Acute Care/Observation	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027AX	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Campus / Family Childbirth/Observation	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027AY	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Orthopedic Institute, Orthopedic Services/Observation	601 Broadway	Seattle	WA	Active
DSH500027AZ	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Cancer Institute, Palliative Care	1221 Madison St	Seattle	WA	Active
DSH500027BA	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Cancer Institute Innovative Therapeutics Unit	1221 Madison St	Seattle	WA	Active
DSH500027BB	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Organ Transplant and Liver Center / Liver Disease	1124 Columbia St	Seattle	WA	Active
DSH500027BC	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Organ Transplant and Liver Center / Pre-transplant Kidney	1124 Columbia St	Seattle	WA	Active
DSH500027BD	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Organ Transplant and Liver Center /Pre Liver Transplant	1124 Columbia St	Seattle	WA	Active
DSH500027BE	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Anticoagulation/Ballard Campus/21570800	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027BF	Child	DSH	SWEDISH MEDICAL CENTER	Swedish First Hill Ambulatory Infusion Center/21072320	1124 Columbia St Suite 420	Seattle	WA	Active
DSH500027BG	Child	DSH	SWEDISH MEDICAL CENTER	Pulmonary Function/21077300	601 Broadway Suite BR-170	Seattle	WA	Active
DSH500027BH	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH MILL CREEK - Emergency Department/23570100	13020 MERIDIAN AVE S	EVERETT	WA	Active
DSH500027BJ	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH IMAGING CLINICS - MillCreek/23576306	13020 MERIDIAN AVE S	EVERETT	WA	Terminated
DSH500027BK	Child	DSH	SWEDISH MEDICAL CENTER	Ballard - Pulmonary Function/21577300	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027BL	Child	DSH	SWEDISH MEDICAL CENTER	Ballard - ECT/21578200	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027BM	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Organ Transplant and Liver Center - Post Transplant Liver/21074223	1124 Columbia St	Seattle	WA	Active
DSH500027BN	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Organ Transplant and Liver Center - Post Transplant Kidney/21074224	1124 Columbia St	Seattle	WA	Active
DSH500027BP	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Ballard - Recovery Room: PACU	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027BQ	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Orthopedic Institute - Recovery Room: PACU	601 Broadway, Floor 2	Seattle	WA	Active
DSH500027BR	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Orthopedic Institute - Surgery And Recovery Services: Pre and Post Op	601 Broadway, Floor 2	Seattle	WA	Active
DSH500027BS	Child	DSH	SWEDISH MEDICAL CENTER	Swedish First Hill - Anticoagulation and Pharmacotherapy, Cherry Hill Campus/1202.12113	500 17th Ave	Seattle	WA	Active
DSH500027E	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH CANCER INSTITUTE EASTSIDE ONCOLOGY AND HEMATOLOGY	13333 BEL-RED ROAD	BELLEVUE	WA	Terminated
DSH500027F	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH CANCER INSTITUTE AT EDMONDS	21632 Highway 99	EDMONDS	WA	Active
DSH500027G	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Cancer Institute (SCI) Issaquah	751 NE Blakely Drive, Suite 1090	Issaquah	WA	Active
DSH500027H	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Campus / Respiratory Therapy	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027J	Child	DSH	SWEDISH MEDICAL CENTER	True Center Breast Imaging	1221 Madison St	Seattle	WA	Terminated
DSH500027K	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Endoscopy Center	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027L	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Campus / General Surgery	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027M	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Cancer Institute, Edmonds Radiation Oncology	21605 76th Ave W	Edmonds	WA	Active
DSH500027N	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Campus / EEG / 21576208	5300 Tallman Ave NW	Seattle	WA	Terminated
DSH500027P	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Campus / Electrocardiology	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027Q	Child	DSH	SWEDISH MEDICAL CENTER	Perinatal Ultrasound	1229 Madison St	Seattle	WA	Terminated
DSH500027R	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Campus / Echocardiology	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027T	Child	DSH	SWEDISH MEDICAL CENTER	Breast Surgery Clinic	1221 Madison St	Seattle	WA	Active
DSH500027U	Child	DSH	SWEDISH MEDICAL CENTER	PERINATAL MEDICINE CLINIC	1229 MADISON STREET	SEATTLE	WA	Terminated
DSH500027V	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Cancer Rehabilitation Services	1229 Madison St	Seattle	WA	Terminated
DSH500027W	Child	DSH	SWEDISH MEDICAL CENTER	Ballard Campus / Anesthesia	5300 Tallman Ave NW	Seattle	WA	Active
DSH500027X	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH BREAST CARE CENTER	1101 MADISON STREET	SEATTLE	WA	Active
DSH500027Y	Child	DSH	SWEDISH MEDICAL CENTER	SWEDISH COMMUNITY SPECIALITY CLINIC	801 BROADWAY	SEATTLE	WA	Terminated
DSH500027Z	Child	DSH	SWEDISH MEDICAL CENTER	Swedish Diabetes Education Center	1124 Columbia St	Seattle	WA	Terminated

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	8/31/2023 1:36:54 PM	8/26/2024 1:29:18 PM	8/26/2024 1:29 PM
Contacts	Primary Contact	Update	Profile Change Request	Lea, Melisa G 340B Program Manager Providence/Swedish 2067560756	Lea, Melisa G 340B Program Manager Providence/Swedish 2067560546	4/10/2024 1:13 PM
Contacts	Authorizing Official	Update	Change Request	Formby, Marybeth Chief Financial Officer Swedish Medical Center 2063863033	Delgado, Eric M Chief Financial Officer Swedish Medical Center First Hill 5622433861	11/15/2023 7:49 AM
Details	Last Recertification Date	Update	Recertification	9/5/2022 2:46:29 PM	8/31/2023 1:36:54 PM	8/31/2023 1:36 PM
Contacts	Primary Contact	Update	Profile Change Request	Lea, Melisa G 340B Program Specialist Lead Swedish Health Services 2067560756	Lea, Melisa G 340B Program Manager Providence/Swedish 2067560756	5/30/2023 12:36 PM
Addresses	Billing Address	Update	Group Change Request	Swedish Health Services Accounts Payable PO BOX 389673 Seattle, WA 98138-9673	Providence St Joseph Health PO BOX 31263 Salt Lake City, UT 84131	4/13/2023 3:40 PM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (IL)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (TN)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (KS)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (NY)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (RI)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (IA)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (FL)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (TX)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (SC)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (VA)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (NC)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1306992151 (UT)		3/22/2023 1:04 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1306992151	3/22/2023 1:04 AM
Medicaid Billing	NPI: State	Insert	Change Request		MT	3/22/2023 1:04 AM
Details	Last Recertification Date	Update	Recertification	9/9/2021 5:48:47 PM	9/5/2022 2:46:29 PM	9/5/2022 2:46 PM
Contacts	Primary Contact	Update	Profile Change Request	Lea, Melisa G 340B Program Specialist Lead Swedish Health Services 2063862327	Lea, Melisa G 340B Program Specialist Lead Swedish Health Services 2067560756	12/20/2021 3:35 PM
Details	Last Recertification Date	Update	Recertification	8/31/2020 7:45:07 AM	9/9/2021 5:48:47 PM	9/9/2021 5:48 PM
Contacts	Authorizing Official	Update	Change Request	Gallagher Felt, Pam CFO Swedish Dwtwn Acute PSJH Swedish Health Services 2066282541	Formby, Marybeth Chief Financial Officer Swedish Medical Center 2063863033	10/9/2020 1:36 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		OR	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		AK	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		ID	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		WA	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		IL	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		TN	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		KS	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		NY	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		RI	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		IA	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		FL	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		TX	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		SC	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		VA	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		NC	8/31/2020 7:45 AM
Medicaid Billing	NPI: Number	Insert	Recertification		1306992151	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Insert	Recertification		UT	8/31/2020 7:45 AM
Medicaid Billing	NPI: State	Update	Recertification		CA	8/31/2020 7:45 AM
Contacts	Primary Contact	Update	Recertification	Lacy, Jim System Director of Pharmacy Services Swedish Health Services 2063202276	Lea, Melisa G 340B Program Specialist Lead Swedish Health Services 2063862327	8/31/2020 7:45 AM
Details	Last Recertification Date	Update	Recertification	9/16/2019 2:43:00 PM	8/31/2020 7:45:07 AM	8/31/2020 7:45 AM
Contacts	Authorizing Official	Update	Change Request	Moser, Stan CFO Swedish medical Center 2066282549	Gallagher Felt, Pam CFO Swedish Dwtwn Acute PSJH Swedish Health Services 2066282541	7/14/2020 10:45 AM
Contacts	Authorizing Official	Update	AO Change Request	Treasure, Jeffrey Stan CFO Swedish Health Services 2063863033	Moser, Stan CFO Swedish medical Center 2066282549	11/14/2019 2:38 PM
Details	Last Recertification Date	Update	Recertification	8/22/2018 4:48:24 PM	9/16/2019 2:43:00 PM	9/16/2019 2:43 PM
Contacts	Authorizing Official	Update	Change Request	Feeney, Sheri Chief Financial Officer Providence Western WA Region 2066282530	Treasure, Jeffrey Stan CFO Swedish Health Services 2063863033	5/16/2019 7:15 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/10/2019 8:07 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1306992151	4/10/2019 8:07 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		ID	4/10/2019 8:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	4/10/2019 8:07 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		1006184	4/10/2019 8:07 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AK	4/10/2019 8:07 PM
Addresses	Shipping Address	Insert	Change Request		Safecor Health LLC 4060 Business Park Dr, Suite B Columbus, OH 43204	12/31/2018 9:15 AM
Addresses	Billing Address	Update	Change Request	Swedish Medical Center 747 Broadway Seattle, WA 98122	Swedish Health Services Accounts Payable PO BOX 389673 Seattle, WA 98138-9673	12/31/2018 9:15 AM
Addresses	Shipping Address	Insert	Recertification		Swedish Medical Center 747 Broadway Seattle, WA 98122	8/22/2018 4:48 PM
Details	Last Recertification Date	Update	Recertification	11/27/2017 4:22:20 PM	8/22/2018 4:48:24 PM	8/22/2018 4:48 PM
Details	Last Recertification Date	Update	Recertification	8/15/2016 12:00:00 AM	11/27/2017 4:22:20 PM	11/27/2017 4:22 PM
Contacts	Authorizing Official	Update		Feeney, Sheri Chief Financial Officer 2066282530	Feeney, Sheri Chief Financial Officer Providence Western WA Region 2066282530	9/26/2017 8:13 PM
Contacts	Primary Contact	Update		Lacy, Jim System Director of Pharmacy Services 2063202276	Lacy, Jim System Director of Pharmacy Services Swedish Health Services 2063202276	9/26/2017 1:37 PM
Contacts	Authorizing Official	Insert			Feeney, Sheri Chief Financial Officer 2066282530	7/17/2017 8:30 PM
Contacts	Primary Contact	Insert			Lacy, Jim System Director of Pharmacy Services 2063202276	3/16/2017 9:14 AM
Contacts	Signed By	Insert			Harris, Dan CFO 2066282550	3/16/2017 9:14 AM
Addresses	Main Address	Insert			601 Broadway Seattle, WA 98122	3/15/2017 5:32 PM
Addresses	Billing Address	Insert			Swedish Medical Center 747 Broadway Seattle, WA 98122	3/15/2017 5:32 PM
Addresses	Shipping Address	Insert			Swedish Medical Center- Receiving Dock 702 Minor Ave Seattle, WA 98104	3/15/2017 5:32 PM
Medicaid Billing	NPI: Number	Insert			1306992151	3/15/2017 5:32 PM
Details	Last Recertification Date	Update		8/19/2015 12:00:00 AM	8/15/2016 12:00:00 AM	8/23/2016 1:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/14/2015 3:52 PM
Medicaid Billing	Medicaid: Number	Insert			034280	9/14/2015 3:52 PM
Medicaid Billing	Medicaid: State	Insert			OR	9/14/2015 3:52 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	9/14/2015 3:52 PM
Medicaid Billing	Medicaid: Number	Insert			3309200	9/14/2015 3:52 PM
Medicaid Billing	Medicaid: State	Insert			WA	9/14/2015 3:52 PM
Details	Last Recertification Date	Update			8/19/2015 12:00:00 AM	8/19/2015 7:29 PM
Dates	Participating Approval Date	Update			5/22/2015 12:00:00 AM	5/22/2015 4:51 PM
Details	State	Update		Pending	Active	5/22/2015 4:51 PM
Dates	Start Date	Update			7/1/2015 12:00:00 AM	5/22/2015 4:51 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG_51530	DSH500027AY	5/21/2015 10:30 AM
Details	Entity Subname	Update		Swedish Orthopedic Institute, Orthopedic Services	Swedish Orthopedic Institute, Orthopedic Services/Observation	5/21/2015 10:30 AM
Details	340B ID	Update			OUTPATIENT_ONLINE_REG_51530	4/14/2015 4:50 PM
Details	Last Recertification Date	Insert				4/14/2015 4:50 PM
Details	Grant Number	Insert				4/14/2015 4:50 PM
Details	340B ID	Insert				4/14/2015 4:50 PM
Details	Is Authorizing Official EHB Data	Insert				4/14/2015 4:50 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/14/2015 4:50 PM
Details	Medicare Provider Number	Insert			500027	4/14/2015 4:50 PM
Details	Entity Name	Insert			SWEDISH MEDICAL CENTER	4/14/2015 4:50 PM
Details	Program Code	Insert			DSH	4/14/2015 4:50 PM
Details	Entity Subname	Insert			Swedish Orthopedic Institute, Orthopedic Services	4/14/2015 4:50 PM
Dates	Participating Approval Date	Insert				4/14/2015 4:50 PM
Details	State	Insert			Pending	4/14/2015 4:50 PM
Dates	Registration Date	Insert			4/14/2015 12:00:00 AM	4/14/2015 4:50 PM
Dates	Signed By Date	Insert			4/14/2015 12:00:00 AM	4/14/2015 4:50 PM
Dates	Start Date	Insert				4/14/2015 4:50 PM
Terminations	Termination Comments	Insert				4/14/2015 4:50 PM
Terminations	Termination Date	Insert				4/14/2015 4:50 PM
Terminations	Termination Effective Date	Insert				4/14/2015 4:50 PM
Terminations	Termination Reason	Insert				4/14/2015 4:50 PM