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TRINITY RETAIL PHARMACY
DSH140280 TRINITY ROCK ISLAND
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Covered Entity Details
Entity Name
TRINITY ROCK ISLAND
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140280
Entity Address
2701 17TH STREET
ROCK ISLAND, IL 61201
Medicare Provider Number
140280
Participating Start Date
7/1/2016
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
TRINITY RETAIL PHARMACY
Pharmacy Address
500 JOHN DEERE RD
TRINITY HEALTH ENTERPRISES,INC
MOLINE, IL 61265
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dave Dellitt, Chief Financial Officer
(309) 779-2218
Contract Pharmacy Representative
Trinity Health Enterprise, Inc. DBA Trinity Retail
Billy McCallister, Manager Regional Ambulatory Pharmacy Services
(309) 779-5011
Signed By Date
10/12/2018
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