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SINA DRUG LLC
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
SINA DRUG LLC
Pharmacy Address
DBA ONCO360
7125 JANES AVE
STE 700
WOODRIDGE, IL 60517
Pharmacy Comments
Contract Details
Approval Date
10/13/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dave Dellitt, Chief Financial Officer
(309) 779-2218
Contract Pharmacy Representative
Sina Drugs dba Onco 360 Illinois
Kimberely Beranek, Director of Pharmacy
(877) 662-6633 Ext: 2101
Signed By Date
10/13/2022
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