Contract Pharmacy Details

BOND DRUG COMPANY OF ILLINOIS, L.L.C.
DSH140048 ADVOCATE SOUTHLAND HEALTH NETWORK

Covered Entity Details

Entity Name

ADVOCATE SOUTHLAND HEALTH NETWORK

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140048

Entity Address

2320 E. 93RD ST.
CHICAGO, IL 60617

Medicare Provider Number

140048

Participating Start Date

10/1/2015

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

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

Pharmacy Address

DBA: WALGREENS # 11109
4800 148TH STREET
MIDLOTHIAN, IL 60445-3117

Pharmacy Comments

Contract Details

Approval Date

12/16/2020

Contract Begin Date

12/21/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Nan Nelson, SVP-Finance
(414) 378-4765

Contract Pharmacy Representative

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

Signed By Date

12/16/2020

340B Drug Pricing Program Database