Contract Pharmacy Details

BOND DRUG COMPANY OF ILLINOIS, L.L.C.
FQHCLA018A SOUTHERN ILLINOIS REGIONAL WELLNESS CENTER

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 # 04024
5890 NORTH BELT WEST
BELLEVILLE, IL 62226

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

340B Drug Pricing Program Database