CLIA lab
CLIA 49D0993104: Costco Pharmacy #204
Fairfax, VA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 49D0993104 belongs to Costco Pharmacy #204 in Fairfax, VA.
Certificate of Waiver, effective November 5, 2025, expires November 4, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- November 5, 2025
- Certificate expiration
- November 4, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- November 5, 2001
- Facility type
- Pharmacy
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 49D0993104
- Lab name
- Costco Pharmacy #204
- Address
- 4725 West Ox Road, Fairfax, VA 22030
- Phone
- (425) 313-8100
- Fax
- (425) 313-6922
Annual test volume the lab reported
- Waived tests
- 10,000,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Costco Pharmacy #204 in Fairfax?
49D0993104, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Costco Pharmacy #204 hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 49D0993104 expire?
The CMS file lists November 4, 2027 as the certificate expiration date; the certificate took effect November 5, 2025.