Contract Pharmacy Details

BOND DRUG COMPANY OF ILLINOIS, L.L.C.
FQHCLA130 HOWARD BROWN HEALTH CENTER

Covered Entity Details

Entity Name

HOWARD BROWN HEALTH CENTER

Subdivision Name

Type

Health Center Program Look-Alike

340B ID

FQHCLA130

Entity Address

4025 NORTH SHERIDAN ROAD
CHICAGO, IL 60613

Grant Number

LALCS00066

Participating Start Date

7/1/2003

Last Recertification Date

2/12/2016

Entity Termination Date

10/1/2016

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

4/20/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2016

Contacts

Covered Entity Signing Official

Kristin Keglovitz-Baker, SVP, Chief Operating Officer
(773) 388-8901

Contract Pharmacy Representative

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

Signed By Date

4/20/2016

340B Drug Pricing Program Database