Contract Pharmacy Details

BARTELL DRUGS #06951
DSH500008 UNIVERSITY OF WASHINGTON MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF WASHINGTON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500008

Entity Address

1959 NE PACIFIC ST.,
SEATTLE, WA 98195

Medicare Provider Number

500008

Participating Start Date

12/1/1992

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

BARTELL DRUGS #06951

Pharmacy Address

6602- 64TH STREET N.E.
MARYSVILLE, WA 98270

Pharmacy Comments

Contract Details

Approval Date

7/11/2018

Contract Begin Date

10/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/31/2021
Ownership change

Contacts

Covered Entity Signing Official

MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362

Contract Pharmacy Representative

Bartell Drugs
Billy Chow, VP of Operations
(206) 455-1305

Signed By Date

7/11/2018

340B Drug Pricing Program Database