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WALGREEN CO.
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
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS # 09267
440 W 10TH AVE
MILAN, IL 61264
Pharmacy Comments
Contract Details
Approval Date
4/4/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dave Dellitt, Chief Financial Officer
(309) 779-2218
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/4/2018
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