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BOND DRUG COMPANY OF ILLINOIS, L.L.C.
DSH140095 SAINT ANTHONY HOSPITAL
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Covered Entity Details
Entity Name
SAINT ANTHONY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140095
Entity Address
2875 WEST 19TH STREET
CHICAGO, IL 60623
Medicare Provider Number
140095
Participating Start Date
7/1/2003
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
BOND DRUG COMPANY OF ILLINOIS, L.L.C.
Pharmacy Address
DBA: WALGREENS # 02785
5840 WEST 35TH ST
CICERO, IL 60804
Pharmacy Comments
Contract Details
Approval Date
9/28/2012
Contract Begin Date
9/28/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jill Stemmerman, Vice President
(773) 484-4470
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
9/28/2012
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