340B Drug Pricing Program Database
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DSH490063AH INOVA FAIRFAX HOSPITAL (Terminated)
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Main Details
Name
INOVA FAIRFAX HOSPITAL
Subdivision Name
Interventional Pulmonology- ISCI - Interventional Pulmonology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490063AH
Medicare Provider Number
490063
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/11/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/22/2021
Last Recertification Date
8/29/2024
Termination Date
Termination Reason
10/1/2024
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
8081 Innovation Park Dr
Pavilion Building (A-Annex)
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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