Contract Pharmacy Details

WALGREEN CO.
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

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03515
8701 GREENWOOD AVE N
SEATTLE, WA 98103

Pharmacy Comments

Contract Details

Approval Date

4/23/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/7/2017
Pharmacy closed

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/23/2014

340B Drug Pricing Program Database