340B Drug Pricing Program Database
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DSH220052K BROCKTON HOSPITAL, INC (Terminated)
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Main Details
Name
BROCKTON HOSPITAL, INC
Subdivision Name
Signature Healthcare Brockton Hospital - Endocrinology Clinic OPD - Endocrinology Clinic OPD
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH220052K
Medicare Provider Number
220052
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/10/2020
Participating Start Date
4/24/2020
Participating Approval Date
4/24/2020
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
130 Quincy Avenue
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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