Contract Pharmacy Details

UNION CENTER PHARMACY
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

UNION CENTER PHARMACY

Pharmacy Address

2324 EASTLAKE AVE E STE 405
SEATTLE, WA 98102-6536

Pharmacy Comments

Contract Details

Approval Date

10/4/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/31/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Kelley-Ross
Alen Chen, Pharmacy Manager
(206) 838-4590

Signed By Date

10/4/2017

340B Drug Pricing Program Database