340B Drug Pricing Program Database
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DSH490063L INOVA FAIRFAX HOSPITAL (Terminated)
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Main Details
Name
INOVA FAIRFAX HOSPITAL
Subdivision Name
Emergency Care Center - Fairfax / Laboratory
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490063L
Medicare Provider Number
490063
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/2/2016
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
7/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
Inova Fairfax
anuj steve narang, President
(480) 737-1397
Primary Contact
Inova Fairfax Medical Campus
Raneesha Ford, Sr. Director, Pharmacy Services
(703) 776-2940
Addresses
Street Address
4315 Chain Bridge Road
Fairfax, VA 22030
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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