340B Drug Pricing Program Database
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DSH140280H TRINITY ROCK ISLAND (Terminated)
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Main Details
Name
TRINITY ROCK ISLAND
Subdivision Name
TRINITY MOLINE / CT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140280H
Medicare Provider Number
140280
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/11/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/4/2016
Last Recertification Date
8/17/2018
Termination Date
Termination Reason
7/1/2019
Business decision by the Covered Entity
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 Rock Island
2701 17th Street
Rock Island, IL 61201
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/4/16 Participating 01/01/2016 until terminated effective 04/01/2016, reinstated effective 7/1/16
05/04/2016
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