340B Drug Pricing Program Database
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DSH160104 TRINITY BETTENDORF (Active)
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Main Details
Name
TRINITY BETTENDORF
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160104
Medicare Provider Number
160104
Additional Details
Current Program Status
Active
Registration Date
1/5/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/14/2017
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
4500 UTICA RIDGE ROAD
BETTENDORF, IA 52722
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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