CLIA lab
CLIA 14D2015177: Walgreens # 04779
Montgomery, IL. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 14D2015177 belongs to Walgreens # 04779 in Montgomery, IL.
Certificate of Waiver, effective May 11, 2025, expires May 10, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- May 11, 2025
- Certificate expiration
- May 10, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- October 22, 2010
- Facility type
- Pharmacy
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 14D2015177
- Lab name
- Walgreens # 04779
- Address
- 1799 Douglas Rd, Montgomery, IL 60538
- Phone
- (630) 896-6960
- Fax
- (630) 896-3205
Annual test volume the lab reported
- Waived tests
- 12,775
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
Other labs in Montgomery, IL
- CSL Plasma, IncCertificate of Compliance, Other14D2131551
- Sam's Club Pharmacy 06388Certificate of Waiver, Pharmacy14D2133008
- Walgreens #10885Certificate of Waiver, Other14D2207136
- Walgreens #11740Certificate of Waiver, Pharmacy14D2222958
- Walmart Pharmacy 10-4286Certificate of Waiver, Pharmacy14D2140368
- Workcare at TimkenCertificate of Waiver, Other14D2279280
Related
Questions
What is the CLIA number for Walgreens # 04779 in Montgomery?
14D2015177, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Walgreens # 04779 hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 14D2015177 expire?
The CMS file lists May 10, 2027 as the certificate expiration date; the certificate took effect May 11, 2025.