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WALGREEN EASTERN CO., INC.
DSH220052 BROCKTON HOSPITAL, INC
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Covered Entity Details
Entity Name
BROCKTON HOSPITAL, INC
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH220052
Entity Address
680 CENTRE STREET
BROCKTON, MA 02302
Medicare Provider Number
220052
Participating Start Date
1/1/2004
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
WALGREEN EASTERN CO., INC.
Pharmacy Address
WALGREENS #19459
51 TREMONT ST
TAUNTON, MA 02780
Pharmacy Comments
Contract Details
Approval Date
7/9/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/22/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
James N. Papadakos, Chief Financial Officer
(508) 941-7570
Contract Pharmacy Representative
Brockton Hospital
Margaret Clapp, Enterprise Director of Pharmacy
(508) 941-7750
Signed By Date
7/9/2018
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