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DSH490063E INOVA FAIRFAX HOSPITAL (Terminated)
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Main Details
Name
INOVA FAIRFAX HOSPITAL
Subdivision Name
Vein and Vascular Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490063E
Medicare Provider Number
490063
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/15/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/30/2015
Last Recertification Date
9/11/2019
Termination Date
Termination Reason
10/1/2020
Site closure
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
13575 Heathcote Blvd.
Suite 200
Gainesville, VA 20155
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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