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UNIV OF WA MED CENTER
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
UNIV OF WA MED CENTER
Pharmacy Address
4245 ROOSEVELT WAY NE
PO BOX 356015
SEATTLE, WA 98105-6015
Pharmacy Comments
Contract Details
Approval Date
7/17/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362
Contract Pharmacy Representative
Donald L. Bomgaars, Director of Pharmacy Services, Supply Chain Management & Contracts, UW Medicine
(206) 598-6055
Signed By Date
7/17/2017
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