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BOND DRUG COMPANY OF ILLINOIS, L.L.C.
DSH140185 MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140185
Entity Address
4500 MEMORIAL DRIVE
BELLEVILLE, IL 62226
Medicare Provider Number
140185
Participating Start Date
7/1/2024
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
BOND DRUG COMPANY OF ILLINOIS, L.L.C.
Pharmacy Address
DBA: WALGREENS # 04832
6505 N. ILLINOIS
FAIRVIEW HEIGHTS, IL 62208
Pharmacy Comments
Contract Details
Approval Date
4/30/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Susan Koesterer, VP, Chief Financial Officer
(314) 653-5715
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
4/10/2024
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