Contract Pharmacy Details

BOND DRUG COMPANY OF ILLINOIS, L.L.C.
DSH140191 INGALLS MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

INGALLS MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140191

Entity Address

ONE INGALLS DRIVE
HARVEY, IL 60426

Medicare Provider Number

140191

Participating Start Date

9/22/2005

Last Recertification Date

8/29/2024

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

1/13/2014

Contract Begin Date

4/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/9/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

KURT E. JOHNSON, CEO
(708) 915-6101

Contract Pharmacy Representative

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

Signed By Date

1/13/2014

340B Drug Pricing Program Database