340B Drug Pricing Program Database
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DSH160104C TRINITY BETTENDORF (Active)
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Main Details
Name
TRINITY BETTENDORF
Subdivision Name
Trinity Bettendorf - Wound Care - Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160104C
Medicare Provider Number
160104
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2024
Participating Start Date
4/1/2024
Participating Approval Date
1/26/2024
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
4480 Utica Ridge Road
110
Bettendorf, IA 52722
Billing Address
Trinity Bettendorf
4500 Utica Ridge Road
Bettendorf, IA 52722
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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