340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
HY-VEE PHARMACY (1416)
DSH140280 TRINITY ROCK ISLAND
Print
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
HY-VEE PHARMACY (1416)
Pharmacy Address
4218 AVENUE OF THE CITIES
MOLINE, IL 61265
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/24/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Dave Dellitt, Chief Financial Officer
(309) 779-2218
Contract Pharmacy Representative
Hy-vee Inc.
Marshall Sanders, 340B Program Manager
(515) 267-6009
Signed By Date
10/13/2016
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session