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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 03604
5409 15TH AVENUE NW
SEATTLE, WA 98107
Pharmacy Comments
Contract Details
Approval Date
4/23/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
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
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