Covered Entity Details

DSH500008BK UNIVERSITY OF WASHINGTON MEDICAL CENTER (Terminated) - information as of 6/21/2025 12:07:14 AM

Main Details

Name

UNIVERSITY OF WASHINGTON MEDICAL CENTER

Subdivision Name

RESPIRATORY THERAPY - RESPIRATORY CARE N

Type

Disproportionate Share Hospital

Rural

340B ID

DSH500008BK

Medicare Provider Number

500008

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

1/15/2021

Participating Start Date

4/1/2021

Participating Approval Date

1/29/2021

Last Recertification Date

8/30/2021

Termination Date
Termination Reason

4/1/2022
Hospital Outpatient facility no longer eligible

Contacts

Authorizing Official

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

Primary Contact

UW Medicine
Sumona Patel, Pharmacy Audit and Compliance Manager
(206) 598-6936

Addresses

Street Address

1550 N 115th St
Seattle, WA 98133

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		1013950336,1326002049,1144641986,1457904625,1760891907,1548635683

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
DSH500008A	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ROOSEVELT	4245 ROOSEVELT	SEATTLE	WA	Terminated
DSH500008AA	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Radiology - Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008AB	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	OR Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008AC	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Exercise Trng Ctr - Roosv	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008AD	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON / ESC Audiology	3100 NORTHUP WAY	BELLEVUE	WA	Active
DSH500008AE	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON / Stadium Clinic - PT	3800 MONTLAKE BLVD	SEATTLE	WA	Active
DSH500008AF	Child	DSH	UNIVERSITY OF WASHINGTON MED CTR	UNIVERSITY OF WASHINGTON / ESC Vascular Lab	3100 NORTHUP WAY	BELLEVUE	WA	Terminated
DSH500008AG	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON / ESC Physical Therapy	3100 NORTHUP WAY	BELLEVUE	WA	Active
DSH500008AH	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ESC Imaging	3100 NORTHUP WAY	BELLEVUE	WA	Active
DSH500008AJ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON / ESC GI Endoscopy	3100 NORTHUP WAY	BELLEVUE	WA	Active
DSH500008AK	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON / ESC Echo Lab	3100 NORTHUP WAY	BELLEVUE	WA	Active
DSH500008AL	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON / Clinic Nutrition-Dietary	4245 ROOSEVELT WAY NE	SEATTLE	WA	Active
DSH500008AM	Child	DSH	UNIVERSITY OF WASHINGTON MED CTR	UWMC Hec Ed Pavilion / ER Med Svc	3870 Montlake Blvd NE	Seattle	WA	Terminated
DSH500008AN	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON / ESC Clinical Lab	3100 NORTHUP WAY	BELLEVUE	WA	Active
DSH500008AP	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON / ESC Clinic Admin Drugs	3100 NORTHUP WAY	BELLEVUE	WA	Active
DSH500008AQ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Headache Clinic	4225 Roosevelt Way NE	Seattle	WA	Active
DSH500008AR	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON MEDICAL CENTER - UWMC Eastside Specialty Center Hospital Based INJECTION	3100 Northup Way	Bellevue	WA	Active
DSH500008AS	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	University of Washington Med Ctr - Computer Tomography ESC	3100 Northup Way	Bellevue	WA	Active
DSH500008AT	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	University of Washington Med Ctr - Ultrasound ESC	3100 Northup Way	Bellevue	WA	Active
DSH500008AU	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	University of Washington Med Ctr - MRI ESC	3100 Northup Way	Bellevue	WA	Active
DSH500008AV	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ANESTHESIOLOGY - INTERNAL MED CONSULT CLINIC	1550 N 115th St.	Seattle	WA	Active
DSH500008AW	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - DEV LAB IMMUNOLOGY U	1550 N 115th St.	Seattle	WA	Active
DSH500008AX	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RESPIRATORY THERAPY - REFERENCE LAB	1550 N 115th St.	Seattle	WA	Terminated
DSH500008AY	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	McMURRAY CV IMAGING CTR - NUCLEAR CARDIOLOGY U NW	1536 N 115th St	Seattle	WA	Active
DSH500008AZ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - LAB PHLEBOTOMY	1550 N 115th St.	Seattle	WA	Terminated
DSH500008B	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UNIVERSITY OF WASHINGTON - MS CLINIC AT NORTHWEST	1536 NORTH 115TH STREET	SEATTLE	WA	Active
DSH500008BA	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	BLOOD STORING, PROCESSING - LAB BLOOD PRODUCTS	1550 N 115th St.	Seattle	WA	Terminated
DSH500008BB	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - RADIOLOGY DIAGNOSIS	3800 Montlake Blvd NE	Seattle	WA	Active
DSH500008BC	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RECOVERY ROOM - POST ANESTHESIA CARE U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008BD	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	BLOOD STORING, PROCESSING - TRANSFUSION SERVICES U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008BE	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - VASCULAR LAB U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008BF	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - CLIN LAB-MICROBIOLGY	1550 N 115th St.	Seattle	WA	Active
DSH500008BG	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - RADIOLOGY	1550 N 115th St.	Seattle	WA	Terminated
DSH500008BH	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	PSYCHIATRY - MRI N	1550 N 115th St	Seattle	WA	Terminated
DSH500008BJ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - RADIOLOGY OPMC	10330 Meridian Ave N	Seattle	WA	Active
DSH500008BK	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RESPIRATORY THERAPY - RESPIRATORY CARE N	1550 N 115th St	Seattle	WA	Terminated
DSH500008BL	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	PHYSICAL THERAPY - PHYSICAL THERAPY N	1550 N 115th St	Seattle	WA	Terminated
DSH500008BM	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Operating Room U NW - U NW OR	1550 N 115th St.	Seattle	WA	Terminated
DSH500008BN	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	OP SURGERY OPMC U NW - UNW OP SURGERY CTR	1550 N 115th St.	Seattle	WA	Active
DSH500008BP	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ELECTROENCEPHALOGRAPHY - EEG U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008BQ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	STRESS TEST - OP CARDIAC REHAB U NW	1536 N 115th St.	Seattle	WA	Active
DSH500008BR	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - PATHOLOGY SATELLITE	1550 N 115th St.	Seattle	WA	Active
DSH500008BS	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - CLIN LAB HEMATOLOGY U NW	1550 N 115th St.	Seattle	WA	Terminated
DSH500008BT	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - LAB POINT OF CARE U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008BU	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	PHYSICAL THERAPY - LUNG FUNCTION U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008BV	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	WOUND CARE CENTER - WOUND CARE CENTER U NW	1560 N 115th Street	Seattle	WA	Active
DSH500008BW	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - DEV LAB GENETICS U	1550 N 115th St.	Seattle	WA	Active
DSH500008BX	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	EMERGENCY - EMERGENCY DEPT PHYSICIANS N	1550 N 115th St	Seattle	WA	Terminated
DSH500008BY	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	PSYCHIATRY - VASCULAR CTR PROCEDURES N	1560 N 115th St	Seattle	WA	Terminated
DSH500008BZ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - DEV LAB VIROLOGY U	1550 N 115th St.	Seattle	WA	Active
DSH500008C	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Psychiatry Clinic Rsvlt	4225 Roosevelt Way NE	Seattle	WA	Active
DSH500008CA	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - ESC VASCULAR LAB	3100 Northup Way	Bellevue	WA	Active
DSH500008CB	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	OPERATING ROOM - INTERVENT RADIOLOGY U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008CC	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	GEOPSYCH OP SERVICES - OP GEROPSYCH U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008CD	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - PURCHASE LAB TESTNG	1550 N 115th St.	Seattle	WA	Active
DSH500008CE	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ELECTROCARDIOLOGY - CARDIOLOGY EPS LAB U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008CF	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - CLIN LAB-HEMATOLOGY	1550 N 115th St.	Seattle	WA	Active
DSH500008CG	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	EMERGENCY - EMERGENCY DEPT N	1550 N 115th St	Seattle	WA	Terminated
DSH500008CH	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	COMPUTED TOMOGRAPHY (CT) SCAN - COMPUTED TOMOGRAPHY U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008CJ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - CLIN LAB MICROBIO U NW	1550 N 115th St.	Seattle	WA	Terminated
DSH500008CK	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RECOVERY ROOM - OP INFUSION SVCS U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008CL	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - CLINICAL LAB SEND OUTS	1550 N 115th St.	Seattle	WA	Active
DSH500008CM	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - SLU LABORATORY	750 Republican St.	Seattle	WA	Active
DSH500008CN	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - ANTI COAG CLINIC U NW	10330 Meridian Ave N	Seattle	WA	Active
DSH500008CP	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	CARDIAC CATHETERIZATION - SEATTLE BREAST CENTER	1560 N 115th Street	Seattle	WA	Terminated
DSH500008CQ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RECOVERY ROOM - POST ANESTHESIA CARE UNIT	1550 N 115th St.	Seattle	WA	Terminated
DSH500008CR	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - DEV LAB COAGULATION U	1550 N 115th St.	Seattle	WA	Active
DSH500008CS	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ELECTROCARDIOLOGY - ECG	10330 Meridian Ave N.	Seattle	WA	Terminated
DSH500008CT	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - ULTRASOUND N	1550 N 115th St.	Seattle	WA	Terminated
DSH500008CU	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	REHABILITATION - RHEUMATOLOGY U	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008CV	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	CHDD Specialty Clinics	1701 NE Columbia Rd.	Seattle	WA	Active
DSH500008CW	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	CARDIOLOGY - ECHO LAB SLU	750 Republican St.	Seattle	WA	Active
DSH500008CX	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ANESTHESIOLOGY - ANESTHESIOLOGY U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008CY	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RECOVERY ROOM - CARDIAC PROCEDURE UNIT U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008CZ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - PHLEBOTOMY SVCS U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008D	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Internal Medicine Clinic at UWMC-Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008DA	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ELECTROCARDIOLOGY - ECHOCARDIOGRAPHY U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DB	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	BREAST CENTER - SEA BREAST CTR MOB U NW	1560 N. 115th	Seattle	WA	Active
DSH500008DC	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOISOTOPE - NUCLEAR MEDICINE U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DD	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ANESTHESIOLOGY - ANESTHESIOLOGY N	1550 N 115th St.	Seattle	WA	Terminated
DSH500008DE	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	PHYSICAL THERAPY - GEROPSYCH OP	1550 N 115th St	Seattle	WA	Terminated
DSH500008DF	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	INTRAVENOUS THERAPY - VASCULAR ACCESS RN U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DG	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	OCCUPATIONAL THERAPY - REHAB-OCCUP THERAPY U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DH	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	NW Therapies OPMC	10330 Meridian Ave N	Seattle	WA	Active
DSH500008DJ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - LAB SEND OUTS	1550 N 115th St.	Seattle	WA	Terminated
DSH500008DK	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ENDOSCOPY - ENDOSCOPY U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DL	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	OPERATING ROOM - INFUSION	1550 N 115th St.	Seattle	WA	Terminated
DSH500008DM	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - DEV LAB STEROIDS U	1550 N 115th St.	Seattle	WA	Active
DSH500008DN	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - PATHOLOGY CONSULTS	1550 N 115th St.	Seattle	WA	Terminated
DSH500008DP	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - DEV LAB ANTIBIOTICS U	1550 N 115th St.	Seattle	WA	Active
DSH500008DQ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	SPEECH PATHOLOGY - SPEECH LANG SVCS	1550 N 115th St	Seattle	WA	Terminated
DSH500008DR	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - ULTRASOUND U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DS	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - OP VASCULAR IMAGING U NW	1560 N 115th Street	Seattle	WA	Active
DSH500008DT	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ELECTROCARDIOLOGY - CARDIOLOGY HEART CATH U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DU	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - CLIN LAB CHEMISTRY	1550 N 115th St.	Seattle	WA	Terminated
DSH500008DV	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	LABORATORY - CLIN LAB CHEMISTRY U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DW	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ELECTROCARDIOLOGY - CARDIOLOGY-ECG U NW	10330 Meridian Ave N.	Seattle	WA	Active
DSH500008DX	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - RADIOLOGY U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008DY	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - RADIOLOGY OPMC U NW	10330 Meridian Ave N,	Seattle	WA	Terminated
DSH500008DZ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	MAGNETIC RESONANCE IMAGING (MRI) - MRI U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008E	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Virology Clinic at UWMC-Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Terminated
DSH500008EA	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	OPERATING ROOM - VASCULAR CTR PROC U NW	1560 N 115th Street	Seattle	WA	Active
DSH500008EB	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RESPIRATORY THERAPY - RESPIRATORY CARE U NW	1550 N 115th St	Seattle	WA	Active
DSH500008EC	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	EMERGENCY - EMERGENCY DEPT U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008ED	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	PHYSICAL THERAPY - REHAB-PHYSICAL THER U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008EE	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	COMPUTED TOMOGRAPHY (CT) SCAN - NUCLEAR MEDICINE N	1550 N 115th St	Seattle	WA	Terminated
DSH500008EF	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	SPEECH PATHOLOGY - REHAB-SPEECH PATH U NW	1550 N 115th St.	Seattle	WA	Active
DSH500008EG	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RESPIRATORY THERAPY - HYPERBARIC OXYGEN U NW	1560 N 115th St	Seattle	WA	Active
DSH500008EH	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	IMPLANTABLE DEVICES CHARGED TO PATIENTS - OPERATING ROOM N	1550 N 115th St.	Seattle	WA	Terminated
DSH500008EJ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - ECHOCARDIOGRAPHY	1550 N 115th St	Seattle	WA	Terminated
DSH500008EK	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	ELECTROENCEPHALOGRAPHY - EEG N	1550 N 115th St.	Seattle	WA	Terminated
DSH500008EL	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RADIOLOGY - DIAGNOSTIC - ULTRASOUND DIAGNOSIS	3800 Montlake Blvd NE	Seattle	WA	Active
DSH500008EM	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	OCCUPATIONAL THERAPY - OCCUPATIONAL THERAPY	1550 N 115th St	Seattle	WA	Terminated
DSH500008EN	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	U NW - Radiation Oncology	1570 N. 115th St.	Seattle	WA	Terminated
DSH500008EP	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC - NW - Gastroenterology U NW	1536 N 115th St.	Seattle	WA	Active
DSH500008EQ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC - KIDNEY DIALYSIS	1550 N 115th St	Seattle	WA	Active
DSH500008ER	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC - ULTRASOUND OPMC	10330 Meridian Ave N	Seattle	WA	Active
DSH500008ES	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC - Mammography ESC	3100 Northup Way	Bellevue	WA	Active
DSH500008ET	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC - ENDOCRINOLOGY U	4225 Roosevelt Way NE	Seattle	WA	Active
DSH500008EU	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC - CVD19 VACCINE DIST UNW	1550 N 115th St	Seattle	WA	Terminated
DSH500008EV	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC - COVID19 SPEC COLLECTION U	1530 N 115TH ST	Seattle	WA	Terminated
DSH500008EW	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC - NW - NW IP Prosthetics & Orthotics	1550 N 115th St	Seattle	WA	Active
DSH500008EX	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	University of Washington - UWMC SLU Heart Institute	750 Republican St.	Seattle	WA	Active
DSH500008EY	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	NW ARTHRITIS CLINIC - NW ARTHRITIS CLINIC	10330 Meridian Ave N.	Seattle	WA	Active
DSH500008EZ	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UROLOGY MCMURRAY U NW - UROLOGY MCMURRAY U NW	1536 N 115th St.	Seattle	WA	Active
DSH500008F	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Dermatologic Surgery Center at UWMC-Roosevelt	4225 Roosevelt Way NE	Seattle	WA	Active
DSH500008FA	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	NW GYN and GYN ONC - NW GYN and GYN ONC	1560 N. 115th St.	Seattle	WA	Active
DSH500008FB	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Computed Tomography OPMC - UNW CT OPMC	10330 Meridian Ave N.	Seattle	WA	Active
DSH500008FC	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	OP SURGERY OPMC U NW - UWMC NW OSC OR	10330 Meridian Ave N	Seattle	WA	Active
DSH500008FD	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	CARDIOLOGY-ECG U NW - UNW ECG	1550 N 115th St.	Seattle	WA	Active
DSH500008FE	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC NW CBHL Geropsychiatry - U NW 6D W	1550 N 115th St.	Seattle	WA	Active
DSH500008FF	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	U NW CBHL NEUROMODULATION - U NW NEUROMOD	1550 N 115th St.	Seattle	WA	Active
DSH500008G	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Dermatology Clinic at UWMC-Roosevelt	4225 Roosevelt Way NE	Seattle	WA	Active
DSH500008H	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Pain Service - Roosevelt	4225 Roosevelt Way NE	Seattle	WA	Active
DSH500008J	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Women's Health Care Center at UWMC-Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008K	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	UWMC Reproductive Care	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008L	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Pediatric Care Center at UWMC-Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008M	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Diabetes Care Center	750 REPUBLICAN ST	Seattle	WA	Active
DSH500008N	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Bone & Joint Surgery Center at UWMC	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008P	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Sports and Spine Clinic	4245 Roosevelt Way NE	Seattle	WA	Terminated
DSH500008Q	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	MLT Heart Institute	24360 Van Ry Boulevard	Mountlake Terrace	WA	Active
DSH500008R	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	RHC Alderwood Echo	24360 Van Ry Boulevard	Mountlake Terrace	WA	Active
DSH500008S	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Stadium Sports Medicine Center	3800 Montlake Blvd	Seattle	WA	Active
DSH500008T	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Weight Loss Center	4225 Roosevelt Way NE	Seattle	WA	Active
DSH500008U	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Men's Health Center	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008W	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	CT Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008X	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Magneic Res. Imaging	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008Y	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Ultrasound Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Active
DSH500008Z	Child	DSH	UNIVERSITY OF WASHINGTON MEDICAL CENTER	Mammography - Roosevelt	4245 Roosevelt Way NE	Seattle	WA	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	4/1/2022 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		1/18/2022 12:00:00 AM	1/14/2022 8:45 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/14/2022 8:45 AM
Terminations	Termination Date	Update	Termination Request		4/1/2022 12:00:00 AM	1/14/2022 8:45 AM
Terminations	Termination Effective Date	Update	Termination Request		1/18/2022 12:00:00 AM	1/14/2022 8:45 AM
Terminations	Termination Reason	Update	Termination Request		Hospital Outpatient facility no longer eligible	1/14/2022 8:45 AM
Details	Last Recertification Date	Update	Recertification		8/30/2021 12:13:08 PM	8/30/2021 12:13 PM
Details	State	Update		Approved	Active	4/1/2021 12:01 AM
Contacts	Signed By	Insert	New Registration		BROOM, MAUREEN Enterprise Finance Officer UW Medicine 2065985362	1/29/2021 9:37 AM
Details	340B ID	Update	New Registration		DSH500008BK	1/29/2021 9:37 AM
Details	Entity Name	Update	New Registration	UNIVERSITY OF WASHINGTON MED CTR	UNIVERSITY OF WASHINGTON MEDICAL CENTER	1/29/2021 9:37 AM
Details	Entity Subname	Update	New Registration	RESPIRATORY THERAPY	RESPIRATORY THERAPY - RESPIRATORY CARE N	1/29/2021 9:37 AM
Dates	Participating Approval Date	Update	New Registration		1/29/2021 9:37:14 AM	1/29/2021 9:37 AM
Details	State	Update	New Registration	Pending	Approved	1/29/2021 9:37 AM
Dates	Signed By Date	Update	New Registration		1/28/2021 12:50:41 PM	1/29/2021 9:37 AM
Dates	Start Date	Update	New Registration		4/1/2021 12:00:00 AM	1/29/2021 9:37 AM
Addresses	Main Address	Insert	New Registration		1550 N 115th St Seattle, WA 98133	1/15/2021 12:53 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1013950336	1/15/2021 12:53 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	1/15/2021 12:53 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1326002049	1/15/2021 12:53 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	1/15/2021 12:53 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1144641986	1/15/2021 12:53 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	1/15/2021 12:53 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1457904625	1/15/2021 12:53 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	1/15/2021 12:53 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1760891907	1/15/2021 12:53 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	1/15/2021 12:53 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1548635683	1/15/2021 12:53 AM
Medicaid Billing	NPI: State	Insert	New Registration		WA	1/15/2021 12:53 AM
Contacts	Authorizing Official	Insert	New Registration		BROOM, MAUREEN Enterprise Finance Officer UW Medicine 2065985362	1/15/2021 12:53 AM
Contacts	Primary Contact	Insert	New Registration		Patel, Sumona Pharmacy Audit and Compliance Manager UW Medicine 2065986936	1/15/2021 12:53 AM
Details	Assistance Received From Date	Insert	New Registration			1/15/2021 12:53 AM
Details	Assistance Received To Date	Insert	New Registration			1/15/2021 12:53 AM
Details	Last Recertification Date	Insert	New Registration			1/15/2021 12:53 AM
Details	Grant Number	Insert	New Registration			1/15/2021 12:53 AM
Details	340B ID	Insert	New Registration			1/15/2021 12:53 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/15/2021 12:53 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/15/2021 12:53 AM
Details	Medicare Provider Number	Insert	New Registration		500008	1/15/2021 12:53 AM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF WASHINGTON MED CTR	1/15/2021 12:53 AM
Details	NOFO Number	Insert	New Registration			1/15/2021 12:53 AM
Details	Program Code	Insert	New Registration		DSH	1/15/2021 12:53 AM
Details	Entity Subname	Insert	New Registration		RESPIRATORY THERAPY	1/15/2021 12:53 AM
Dates	Participating Approval Date	Insert	New Registration			1/15/2021 12:53 AM
Details	State	Insert	New Registration		Pending	1/15/2021 12:53 AM
Dates	Registration Date	Insert	New Registration		1/15/2021 12:53:00 AM	1/15/2021 12:53 AM
Dates	Signed By Date	Insert	New Registration			1/15/2021 12:53 AM
Dates	Start Date	Insert	New Registration			1/15/2021 12:53 AM
Terminations	Termination Comments	Insert	New Registration			1/15/2021 12:53 AM
Terminations	Termination Date	Insert	New Registration			1/15/2021 12:53 AM
Terminations	Termination Effective Date	Insert	New Registration			1/15/2021 12:53 AM
Terminations	Termination Reason	Insert	New Registration			1/15/2021 12:53 AM