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BOND DRUG COMPANY OF ILLINOIS, L.L.C.
CH052760 CRUSADERS CENTRAL CLINIC ASSOCIATION
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Covered Entity Details
Entity Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Clinic on West State Street
Type
HRSA-Funded Health Center
340B ID
CH052760
Entity Address
1200 W State St
Rockford, IL 61102-2112
Grant Number
H80CS00113
Participating Start Date
12/1/1992
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
BOND DRUG COMPANY OF ILLINOIS, L.L.C.
Pharmacy Address
DBA: WALGREENS # 06003
3336 11TH STREET
ROCKFORD, IL 61109
Pharmacy Comments
Contract Details
Approval Date
11/7/2011
Contract Begin Date
11/7/2011
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
GORDON EGGERS JR., CEO
(815) 490-1616
Contract Pharmacy Representative
Thomas W. Woller, SVP, Pharmacy Services
(414) 382-1829
Signed By Date
10/28/2011
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