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DSH500008A UNIVERSITY OF WASHINGTON MEDICAL CENTER (Terminated)
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Main Details
Name
UNIVERSITY OF WASHINGTON MEDICAL CENTER
Subdivision Name
ROOSEVELT
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500008A
Medicare Provider Number
500008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
11/21/2007
Participating Start Date
7/1/1995
Participating Approval Date
11/21/2007
Last Recertification Date
8/21/2014
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 AND CONTRACTS, UW MEDICINE
(206) 598-6055
Addresses
Street Address
4245 ROOSEVELT
SEATTLE, WA 98105
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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11/6/07 UPDATED MEDICAID # (WAS 6001028)
01/14/2010
May 2025
May 2025
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