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DSH140280P TRINITY ROCK ISLAND (Active)
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Main Details
Name
TRINITY ROCK ISLAND
Subdivision Name
TRINITY MOLINE / Labor/Delivery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140280P
Medicare Provider Number
140280
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/11/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/12/2016
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
500 JOHN DEERE RD
MOLINE, IL 61265-6892
Billing Address
Trinity Moline
500 John Deere Road
Moline, IL 61265
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/27/16 participating 1/1/16 until terminated effective 4/1/16, reinstated effective 7/1/16
05/27/2016
Comments 5/27/16 participating 1/1/16 until terminated effective 4/1/16, reinstated effective 7/1/16
05/27/2016
April 2025
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