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BARTELL DRUGS #06924
DSH500008 UNIVERSITY OF WASHINGTON MEDICAL CENTER
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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
BARTELL DRUGS #06924
Pharmacy Address
6401 12TH AVE 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
10/31/2021
Ownership change
Contacts
Covered Entity Signing Official
PAUL S. ISHIZUKA, ASSOC. EXEC. DIR & CFO
(206) 598-6305
Contract Pharmacy Representative
Peter Koo, Senior Vice President of Pharmacy
(206) 767-1316
Signed By Date
10/14/2013
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