340B Drug Pricing Program Database
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DSH220052C BROCKTON HOSPITAL, INC (Terminated)
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Main Details
Name
BROCKTON HOSPITAL, INC
Subdivision Name
Signature Healthcare Brockton Hospital Raynham Internal Medicine - Internal Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220052C
Medicare Provider Number
220052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/24/2018
Participating Start Date
7/1/2018
Participating Approval Date
4/26/2018
Last Recertification Date
9/5/2023
Termination Date
Termination Reason
4/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Brockton Hospital
Stephen Borges, Vice President, Finance Operations
(508) 941-7571
Primary Contact
Brockton Hospital
Margaret Clapp, Enterprise Director of Pharmacy
(508) 941-7750
Addresses
Street Address
1215 Broadway
Raynham, MA 02767
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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