Contract Pharmacy Details

PROSPERITY PHARMACY
RWII22151 INOVA HEALTH CARE SERVICES DBA INOVA JUNIPER PROGRAM

Covered Entity Details

Entity Name

INOVA HEALTH CARE SERVICES DBA INOVA JUNIPER PROGRAM

Subdivision Name

Type

Ryan White Part B

340B ID

RWII22151

Entity Address

2740 Prosperity Avenue
SUITE 200
Fairfax, VA 22032

Grant Number

X07HA00009

Participating Start Date

10/1/2019

Last Recertification Date

1/30/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

PROSPERITY PHARMACY

Pharmacy Address

8505 ARLINGTON BOULEVARD
SUITE 110
FAIRFAX, VA 22031

Pharmacy Comments

Contract Details

Approval Date

5/15/2009

Contract Begin Date

5/15/2009

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/10/2015
Ownership change

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

5/7/2009

340B Drug Pricing Program Database