Contract Pharmacy Details

BOND DRUG COMPANY OF ILLINOIS, L.L.C.
DSH140206 Humboldt Park Health

Covered Entity Details

Entity Name

Humboldt Park Health

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140206

Entity Address

1044 N FRANCISCO AVENUE
CHICAGO, IL 60622

Medicare Provider Number

140206

Participating Start Date

7/1/2004

Last Recertification Date

9/6/2024

Pharmacy Details

Pharmacy Name

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

Pharmacy Address

DBA: WALGREENS # 01310
3110 W ARMITAGE
CHICAGO, IL 60647

Pharmacy Comments

Contract Details

Approval Date

1/18/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Gary Krugel, CFO
(773) 292-8208

Contract Pharmacy Representative

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

Signed By Date

1/18/2016

340B Drug Pricing Program Database