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SAFEWAY INC
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
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1508
3820 RAINER AVE S.
SEATTLE, WA 98118
Pharmacy Comments
Contract Details
Approval Date
10/11/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2015
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lori Mitchell, CFO, UW Medicine
(206) 616-9886
Contract Pharmacy Representative
Safeway
Thuy Le, 340B Program Manager
(925) 467-2825
Signed By Date
10/11/2013
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