Contract Pharmacy Details

BOND DRUG COMPANY OF ILLINOIS, L.L.C.
SCH140064-00 ST. MARY MEDICAL CENTER

Covered Entity Details

Entity Name

ST. MARY MEDICAL CENTER

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH140064-00

Entity Address

3333 N SEMINARY
GALESBURG, IL 61401

Medicare Provider Number

140064

Participating Start Date

4/1/2025

Last Recertification Date

Pharmacy Details

Pharmacy Name

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

Pharmacy Address

DBA: WALGREENS # 04504
844 W FREMONT ST
GALESBURG, IL 61401

Pharmacy Comments

Contract Details

Approval Date

7/6/2022

Contract Begin Date

10/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Diane L. McGrew, President
(309) 655-2850

Contract Pharmacy Representative

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

Signed By Date

7/6/2022

340B Drug Pricing Program Database