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DSH500064R HARBORVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
HARBORVIEW MEDICAL CENTER
Subdivision Name
Pioneer Square Heathcare for Homeless
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500064R
Medicare Provider Number
500064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/4/2022
Participating Start Date
4/1/2022
Participating Approval Date
3/10/2022
Last Recertification Date
8/28/2024
Termination Date
Termination Reason
4/1/2025
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
206 3rd Avenue South
Seattle, WA 98104
Billing Address
UW Medicine
PO BOX 45404
Seattle, WA 98145
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participating from effective date: (10/1/2013) until terminated effective date; (07/01/2015), reinstatement effective date: (04/01/2022)
03/10/2022
April 2025
April 2025
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