340B Drug Pricing Program Database
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DSH490063AS INOVA FAIRFAX HOSPITAL (Active)
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Main Details
Name
INOVA FAIRFAX HOSPITAL
Subdivision Name
ICPH Pre Abdominal Transplant Clinic - Transplant
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490063AS
Medicare Provider Number
490063
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/9/2024
Participating Start Date
7/1/2024
Participating Approval Date
6/4/2024
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Inova Fairfax
anuj steve narang, President
(480) 737-1397
Primary Contact
Inova Fairfax Medical Campus
Christiana Showunmi, 340B Program Manager
(240) 483-3843
Addresses
Street Address
8081 Innovation Park Drive
Building A
Suite 604
Fairfax, VA 22031
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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