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GENOA HEALTHCARE LLC
DSH500064 HARBORVIEW MEDICAL CENTER
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Covered Entity Details
Entity Name
HARBORVIEW MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH500064
Entity Address
325 9TH AVE.
SEATTLE, WA 98104-2499
Medicare Provider Number
500064
Participating Start Date
12/1/1992
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
11000 LAKE CITY WAY NE STE 421
SEATTLE, WA 98125
Pharmacy Comments
Contract Details
Approval Date
4/15/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362
Contract Pharmacy Representative
UW Medicine
Sumona Patel, Pharmacy Audit and Compliance Manager
(206) 598-6936
Signed By Date
4/15/2021
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