340B Drug Pricing Program Database

Name

INOVA FAIRFAX HOSPITAL

Subdivision Name

Abdominal Transplant Clinic - Post Transplant Abdominal

Type

Disproportionate Share Hospital

Rural

No

340B ID

DSH490063V

Medicare Provider Number

490063

Outpatient Facility Provider Number

Current Program Status

Terminated

Registration Date

10/11/2019

Participating Start Date

1/1/2020

Participating Approval Date

11/6/2019

Last Recertification Date

Termination Date
Termination Reason

7/1/2020
Business decision by the Covered Entity

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

Street Address

3300 Gallows Road
Falls Church, VA 22042

Billing Address
Same as Street Address