Contract Pharmacy Details

PROSPERITY PHARMACY
RW422151 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 D

340B ID

RW422151

Entity Address

2740 Prosperity Avenue
SUITE 200
Fairfax, VA 22032

Grant Number

H12HA23011

Participating Start Date

4/1/2007

Last Recertification Date

2/29/2016

Entity Termination Date

10/1/2016

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
Pharmacy closed

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

5/7/2009

340B Drug Pricing Program Database