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DSH490063U INOVA FAIRFAX HOSPITAL (Terminated)
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Main Details
Name
INOVA FAIRFAX HOSPITAL
Subdivision Name
Abdominal Transplant Clinic - Pre-Kidney Transplant
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490063U
Medicare Provider Number
490063
Outpatient Facility Provider Number
Additional Details
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
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
3300 Gallows Road
Falls Church, VA 22042
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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