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BOND DRUG COMPANY OF ILLINOIS, L.L.C.
FQHCLA018A SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER
Subdivision Name
THE HEALTH AND OPPORTUNITY CENTER
Type
Health Center Program Look-Alike
340B ID
FQHCLA018A
Entity Address
1736 KINGSHIGHWAY
WASHINGTON PARK, IL 62204
Grant Number
LALCS00022
Participating Start Date
7/1/2001
Last Recertification Date
2/4/2019
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
BOND DRUG COMPANY OF ILLINOIS, L.L.C.
Pharmacy Address
DBA: WALGREENS # 03136
1201 CAMP JACKSON
CAHOKIA, IL 62206
Pharmacy Comments
Contract Details
Approval Date
2/10/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mark Freeland, Executive Director
(618) 482-7922 Ext: 601
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
2/10/2014
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