Contract Pharmacy Details

HARBORVIEW MEDICAL CENTER OUTPATIENT PHA
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

HARBORVIEW MEDICAL CENTER OUTPATIENT PHA

Pharmacy Address

325 9TH AVE
MAILSTOP 359912
SEATTLE, WA 98104-2420

Pharmacy Comments

Contract Details

Approval Date

7/17/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MAUREEN BROOM, Enterprise Finance Officer
(206) 598-5362

Contract Pharmacy Representative

Donald L. Bomgaars, Director of Pharmacy Services, Supply Chain Management & Contracts, UW Medicine
(206) 598-6055

Signed By Date

7/17/2017

340B Drug Pricing Program Database