Covered Entity Details

DSH140280Y TRINITY ROCK ISLAND (Active) - information as of 5/13/2025 11:06:37 PM

Main Details

Name

TRINITY ROCK ISLAND

Subdivision Name

UnityPoint Health Trinity Rock Island Multi Specialty Clinic - Pulmonology

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH140280Y

Medicare Provider Number

140280

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

1/11/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/23/2024

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

UnityPoint-Trinity
Dave Dellitt, Chief Financial Officer
(309) 779-2218

Primary Contact

UnityPoint - Trinity
Jaime Graves, 340B Pharmacy Coordinator
(309) 779-5030

Addresses

Street Address

2560 24th Street
102
Rock Island, IL 61201

Billing Address

Trinity Rock Island
2701 17th Street
Rock Island, IL 61201

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IL	362739299001	1316047632
IA	0901363	1316047632
WI		1316047632

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH140280A	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Obstetrics Emergency Department	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280B	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Emergency Department	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280C	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Wound Center-Clinic	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280D	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Pain Management-Clinic	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280E	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Sleep Lab- Electroencephalography	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280F	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Respiratory Care/Respiratory Therapy	500 JOHN DEERE RD	MOLINE	IL	Terminated
DSH140280G	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Trinity Infusion Center	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280H	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / CT	500 JOHN DEERE RD	MOLINE	IL	Terminated
DSH140280J	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Cancer Center	500 JOHN DEERE RD	MOLINE	IL	Terminated
DSH140280K	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Non Invasive Diagnostic Technology	500 JOHN DEERE RD	MOLINE	IL	Terminated
DSH140280L	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Nuclear Medicine- Diagnostic	500 JOHN DEERE RD	MOLINE	IL	Terminated
DSH140280M	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Women's Imaging- Radiology/Diagnostics	500 JOHN DEERE RD	MOLINE	IL	Terminated
DSH140280N	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Diagnostic Radiology	500 JOHN DEERE RD	MOLINE	IL	Terminated
DSH140280P	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Labor/Delivery	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280Q	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Post Acute Care Unit- Recovery Room	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280R	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Ambulatory Services- Recovery Room	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280S	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Operations Room	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280T	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / Recovery Care Center- Adults & Peds	500 JOHN DEERE RD	MOLINE	IL	Active
DSH140280U	Child	DSH	TRINITY ROCK ISLAND	TRINITY MOLINE / OUTPATIENT OBSERVATION BEDS - Mother / Baby	500 John Deere Road	Moline	IL	Active
DSH140280V	Child	DSH	TRINITY ROCK ISLAND	UnityPoint Health Trinity Rock Island Multi Specialty Clinic - Multi Specialty	2570 24TH STREET	ROCK ISLAND	IL	Active
DSH140280W	Child	DSH	TRINITY ROCK ISLAND	UnityPoint Health Trinity Rock Island Multi Specialty Clinic - Podiatry	2570 24TH STREET	ROCK ISLAND	IL	Active
DSH140280X	Child	DSH	TRINITY ROCK ISLAND	UnityPoint Health - Trinity Medical Oncology and Hematology - Oncology	500 John Deere Road	Moline	IL	Active
DSH140280Y	Child	DSH	TRINITY ROCK ISLAND	UnityPoint Health Trinity Rock Island Multi Specialty Clinic - Pulmonology	2560 24th Street	Rock Island	IL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification		8/14/2024 8:17:22 AM	8/14/2024 8:17 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Authorizing Official	Update	Profile Change Request	Dellitt, Dave Director of Finance UnityPoint-Trinity 3097792954	Dellitt, Dave Chief Financial Officer UnityPoint-Trinity 3097792218	2/16/2024 6:15 AM
Contacts	Signed By	Update	Profile Change Request	Dellitt, Dave Director of Finance UnityPoint-Trinity 3097792954	Dellitt, Dave Chief Financial Officer UnityPoint-Trinity 3097792218	2/16/2024 6:15 AM
Contacts	Signed By	Insert	New Registration		Dellitt, Dave Director of Finance UnityPoint-Trinity 3097792954	1/23/2024 6:54 AM
Details	340B ID	Update	New Registration		DSH140280Y	1/23/2024 6:54 AM
Details	Entity Subname	Update	New Registration	UnityPoint Health Trinity Rock Island Multi Specialty Clinic	UnityPoint Health Trinity Rock Island Multi Specialty Clinic - Pulmonology	1/23/2024 6:54 AM
Dates	Participating Approval Date	Update	New Registration		1/23/2024 6:54:54 AM	1/23/2024 6:54 AM
Details	State	Update	New Registration	Pending	Approved	1/23/2024 6:54 AM
Dates	Signed By Date	Update	New Registration		1/11/2024 11:41:37 AM	1/23/2024 6:54 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/23/2024 6:54 AM
Addresses	Main Address	Insert	New Registration		2560 24th Street 102 Rock Island, IL 61201	1/11/2024 10:12 AM
Addresses	Billing Address	Insert	New Registration		Trinity Rock Island 2701 17th Street Rock Island, IL 61201	1/11/2024 10:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 10:12 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		362739299001	1/11/2024 10:12 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	1/11/2024 10:12 AM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/11/2024 10:12 AM
Medicaid Billing	Medicaid: Number	Insert	New Registration		0901363	1/11/2024 10:12 AM
Medicaid Billing	Medicaid: State	Insert	New Registration		IA	1/11/2024 10:12 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1316047632	1/11/2024 10:12 AM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/11/2024 10:12 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1316047632	1/11/2024 10:12 AM
Medicaid Billing	NPI: State	Insert	New Registration		IA	1/11/2024 10:12 AM
Medicaid Billing	NPI: Number	Insert	New Registration		1316047632	1/11/2024 10:12 AM
Medicaid Billing	NPI: State	Insert	New Registration		WI	1/11/2024 10:12 AM
Contacts	Primary Contact	Insert	New Registration		Graves, Jaime 340B Pharmacy Coordinator UnityPoint - Trinity 3097795030	1/11/2024 10:12 AM
Contacts	Authorizing Official	Insert	New Registration		Dellitt, Dave Director of Finance UnityPoint-Trinity 3097792954	1/11/2024 10:12 AM
Details	Assistance Received From Date	Insert	New Registration			1/11/2024 10:12 AM
Details	Assistance Received To Date	Insert	New Registration			1/11/2024 10:12 AM
Details	Last Recertification Date	Insert	New Registration			1/11/2024 10:12 AM
Details	Grant Number	Insert	New Registration			1/11/2024 10:12 AM
Details	340B ID	Insert	New Registration			1/11/2024 10:12 AM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/11/2024 10:12 AM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/11/2024 10:12 AM
Details	Medicare Provider Number	Insert	New Registration		140280	1/11/2024 10:12 AM
Details	Entity Name	Insert	New Registration		TRINITY ROCK ISLAND	1/11/2024 10:12 AM
Details	NOFO Number	Insert	New Registration			1/11/2024 10:12 AM
Details	Program Code	Insert	New Registration		DSH	1/11/2024 10:12 AM
Details	Entity Subname	Insert	New Registration		UnityPoint Health Trinity Rock Island Multi Specialty Clinic	1/11/2024 10:12 AM
Dates	Participating Approval Date	Insert	New Registration			1/11/2024 10:12 AM
Details	State	Insert	New Registration		Pending	1/11/2024 10:12 AM
Dates	Registration Date	Insert	New Registration		1/11/2024 10:12:03 AM	1/11/2024 10:12 AM
Dates	Signed By Date	Insert	New Registration			1/11/2024 10:12 AM
Dates	Start Date	Insert	New Registration			1/11/2024 10:12 AM
Terminations	Termination Comments	Insert	New Registration			1/11/2024 10:12 AM
Terminations	Termination Date	Insert	New Registration			1/11/2024 10:12 AM
Terminations	Termination Effective Date	Insert	New Registration			1/11/2024 10:12 AM
Terminations	Termination Reason	Insert	New Registration			1/11/2024 10:12 AM