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DSH500008Y UNIVERSITY OF WASHINGTON MEDICAL CENTER (Active)
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Main Details
Name
UNIVERSITY OF WASHINGTON MEDICAL CENTER
Subdivision Name
Ultrasound Roosevelt
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500008Y
Medicare Provider Number
500008
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/30/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/5/2014
Last Recertification Date
8/28/2024
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
4245 Roosevelt Way NE
Seattle, WA 98105-6015
Billing Address
UW Medicine
PO BOX 45404
Seattle, WA 98145
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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