Contract Pharmacy Details

BOND DRUG COMPANY OF ILLINOIS, L.L.C.
FQHCLA375A INNER CITY MUSLIM ACTION NETWORK

Covered Entity Details

Entity Name

INNER CITY MUSLIM ACTION NETWORK

Subdivision Name

IMAN-Oral Health Center

Type

Health Center Program Look-Alike

340B ID

FQHCLA375A

Entity Address

2744 W. 63rd St., Building #2
Chicago, IL 60629

Grant Number

LALCS31661

Participating Start Date

10/1/2018

Last Recertification Date

2/4/2020

Entity Termination Date

7/1/2020

Pharmacy Details

Pharmacy Name

BOND DRUG COMPANY OF ILLINOIS, L.L.C.

Pharmacy Address

WALGREENS # 16525
5401 S WENTWORTH AVE
SUITE 5A1
CHICAGO, IL 60609

Pharmacy Comments

Contract Details

Approval Date

1/3/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2020
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Constance Shabazz, Senior Director of Operations
(773) 434-4626

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

1/3/2019

340B Drug Pricing Program Database