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DSH500064AJ HARBORVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
HARBORVIEW MEDICAL CENTER
Subdivision Name
Ear Nose Throat Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500064AJ
Medicare Provider Number
500064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/30/2014
Participating Start Date
1/1/2015
Participating Approval Date
11/5/2014
Last Recertification Date
8/6/2015
Termination Date
Termination Reason
4/1/2016
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 Management & Contracts, UW Medicine
(206) 598-6055
Addresses
Street Address
908 Jefferson
Seattle, WA 98104-2499
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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