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DSH500064BN HARBORVIEW MEDICAL CENTER (Terminated)
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Main Details
Name
HARBORVIEW MEDICAL CENTER
Subdivision Name
Harborview Medical Center - Operating Room H
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH500064BN
Medicare Provider Number
500064
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/12/2022
Participating Start Date
4/1/2022
Participating Approval Date
3/3/2022
Last Recertification Date
8/28/2023
Termination Date
Termination Reason
10/1/2024
Site closure
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
410 9th Ave
Seattle, WA 98104
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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