340B Drug Pricing Program Database
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DSH220052AF BROCKTON HOSPITAL, INC (Terminated)
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Main Details
Name
BROCKTON HOSPITAL, INC
Subdivision Name
BH Urgent Care 650 Centre - Urgent Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220052AF
Medicare Provider Number
220052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/3/2024
Participating Start Date
7/1/2024
Participating Approval Date
4/11/2024
Last Recertification Date
8/13/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Brockton Hospital
Margaret Clapp, Enterprise Director of Pharmacy
(508) 941-7750
Primary Contact
Signature Healthcare Brockton Hospital
Christine Canty, 340B Business Operations Manager
(508) 941-7186
Addresses
Street Address
650 Centre Street
Brockton, MA 02302
Billing Address
Signature Healthcare Brockton Hospital, Inc.
680 Centre Street
Brockton, MA 02302
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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