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FRED MEYER STORES 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
FRED MEYER STORES INC
Pharmacy Address
13000 LAKE CITY WAY NE
SEATTLE, WA 98125-4429
Pharmacy Comments
Contract Details
Approval Date
7/30/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/4/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lori Mitchell, CFO, UW Medicine
(206) 616-9886
Contract Pharmacy Representative
Kroger
Mike Puccini, New Business Development Manager
(513) 762-4672
Signed By Date
7/30/2015
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