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EVERGREEN PHARMACEUTICAL 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
EVERGREEN PHARMACEUTICAL LLC
Pharmacy Address
OMNICARE OF SEATTLE
12674 GATEWAY DR S
TUKWILA, WA 98168-3307
Pharmacy Comments
Contract Details
Approval Date
1/3/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jacqueline L Cabe, Chief Financial Officer
(206) 616-9886
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/3/2024
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