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INOVA RETAIL AND SPECIALTY PHARMACY
HV220311D Inova Juniper Program
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Covered Entity Details
Entity Name
Inova Juniper Program
Subdivision Name
Falls Church
Type
Ryan White Part C
340B ID
HV220311D
Entity Address
500 North Washington Street
Suite 200
Falls Church, VA 22046
Grant Number
H76HA00177
Participating Start Date
7/1/2016
Last Recertification Date
2/18/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
INOVA RETAIL AND SPECIALTY PHARMACY
Pharmacy Address
3901 STONECROFT BLVD STE A1400
CHANTILLY, VA 20151
Pharmacy Comments
Contract Details
Approval Date
7/12/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Karen Berube, VP Population Health
(703) 698-2545
Contract Pharmacy Representative
Inova Health System
Melanie Massiah-White, Executive Director Chief Pharmacy Officer
(703) 205-2140
Signed By Date
7/12/2019
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