Contract Pharmacy Details

BOND DRUG COMPANY OF ILLINOIS, L.L.C.
DSH140182 ADVOCATE NORTH SIDE HEALTH NETWORK

Covered Entity Details

Entity Name

ADVOCATE NORTH SIDE HEALTH NETWORK

Subdivision Name

DBA ADVOCATE ILLINOIS MASONIC MEDICAL CENTER (AIMMC)

Type

Disproportionate Share Hospital

340B ID

DSH140182

Entity Address

836 West Wellington Ave.
CHICAGO, IL 60657

Medicare Provider Number

140182

Participating Start Date

10/27/2005

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

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

Pharmacy Address

DBA: WALGREENS # 05121
5935 W ADDISON
CHICAGO, IL 60634

Pharmacy Comments

Contract Details

Approval Date

7/7/2021

Contract Begin Date

10/1/2021

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

7/7/2021

340B Drug Pricing Program Database