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BOND DRUG COMPANY OF ILLINOIS, L.L.C.
DSH140209 METHODIST MEDICAL CENTER OF ILLINOIS
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Covered Entity Details
Entity Name
METHODIST MEDICAL CENTER OF ILLINOIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140209
Entity Address
221 NE GLEN OAK AVE.
PEORIA, IL 61636
Medicare Provider Number
140209
Participating Start Date
10/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
BOND DRUG COMPANY OF ILLINOIS, L.L.C.
Pharmacy Address
DBA: WALGREENS # 05544
1200 E WAR MEMORIAL DR
PEORIA HEIGHTS, IL 61616
Pharmacy Comments
02/08/2012 updated city (was Peoria)
Contract Details
Approval Date
10/26/2012
Contract Begin Date
10/26/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DEBORAH R. SIMON, PRESIDENT AND CEO
(309) 672-5929
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/12/2012
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