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BOND DRUG COMPANY OF ILLINOIS, L.L.C.
RRC140064-00 ST. MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. MARY MEDICAL CENTER
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140064-00
Entity Address
3333 N SEMINARY
GALESBURG, IL 61401
Medicare Provider Number
140064
Participating Start Date
7/1/2018
Last Recertification Date
8/26/2021
Entity Termination Date
7/1/2022
Pharmacy Details
Pharmacy Name
BOND DRUG COMPANY OF ILLINOIS, L.L.C.
Pharmacy Address
DBA: WALGREENS # 04504
844 W FREMONT ST
GALESBURG, IL 61401
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
1/15/2019
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