Contract Pharmacy Details

SAFEWAY INC
DSH500008 UNIVERSITY OF WASHINGTON MEDICAL CENTER

Covered Entity Details

Entity Name

UNIVERSITY OF WASHINGTON MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH500008

Entity Address

1959 NE PACIFIC ST.,
SEATTLE, WA 98195

Medicare Provider Number

500008

Participating Start Date

12/1/1992

Last Recertification Date

8/28/2024

Pharmacy Details

Pharmacy Name

SAFEWAY INC

Pharmacy Address

SAFEWAY PHARMACY #1550
7300 ROOSEVELT WAY NE
SEATTLE, WA 98115

Pharmacy Comments

Contract Details

Approval Date

10/14/2013

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

PAUL S. ISHIZUKA, ASSOC. EXEC. DIR & CFO
(206) 598-6305

Contract Pharmacy Representative

Safeway
Thuy Le, 340B Program Manager
(925) 467-2825

Signed By Date

10/14/2013

340B Drug Pricing Program Database