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DSH500027N SWEDISH MEDICAL CENTER (Terminated)
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Main Details
Name
SWEDISH MEDICAL CENTER
Subdivision Name
Ballard Campus / EEG / 21576208
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH500027N
Medicare Provider Number
500027
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/15/2015
Last Recertification Date
9/5/2022
Termination Date
Termination Reason
4/1/2023
Site closure
Contacts
Authorizing Official
Swedish Medical Center
Marybeth Formby, Chief Financial Officer
(206) 386-3033
Primary Contact
Providence/Swedish
Melisa G Lea, 340B Program Manager
(206) 756-0546
Addresses
Street Address
5300 Tallman Ave NW
Suite NW 200.002
Seattle, WA 98107
Billing Address
Providence St Joseph Health
PO BOX 31263
Salt Lake City, UT 84131
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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