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DSH500064BD HARBORVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
HARBORVIEW MEDICAL CENTER
Subdivision Name
CHRONIC FATIGUE CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500064BD
Medicare Provider Number
500064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2016
Participating Start Date
4/1/2016
Participating Approval Date
2/19/2016
Last Recertification Date
8/21/2018
Termination Date
Termination Reason
10/1/2019
Hospital Outpatient facility no longer eligible
Contacts
Authorizing Official
UW Medicine
MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362
Primary Contact
UW Medicine
Sumona Patel, Pharmacy Audit and Compliance Manager
(206) 598-6936
Addresses
Street Address
410 9th Avenue
Seattle, WA 98104-2499
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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