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SAFEWAY INC
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
SAFEWAY INC
Pharmacy Address
SAFEWAY PHARMACY #1993
2201 E MADISON ST
SEATTLE, WA 98112
Pharmacy Comments
Contract Details
Approval Date
1/16/2014
Contract Begin Date
4/1/2014
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
1/16/2014
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