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DSH500064Z HARBORVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
HARBORVIEW MEDICAL CENTER
Subdivision Name
Pioneer Square 2nd Avenue Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500064Z
Medicare Provider Number
500064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/13/2022
Participating Start Date
7/1/2022
Participating Approval Date
5/19/2022
Last Recertification Date
8/28/2023
Termination Date
Termination Reason
4/1/2024
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
UW Medicine
Jacqueline L Cabe, Chief Financial Officer
(206) 616-9886
Primary Contact
UW Medicine
Sumona Patel, Pharmacy Audit and Compliance Manager
(206) 598-6936
Addresses
Street Address
2124 4th Ave
Seattle, WA 98101
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2013) until terminated effective date: (7/1/2015), reinstatement effective date: (07/01/2022)
05/19/2022
April 2025
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