340B Drug Pricing Program Database
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CVS PHARMACY, 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
CVS PHARMACY, INC.
Pharmacy Address
DBA: CVS/PHARMACY # 02325
1025 CENTRAL STREET
STOUGHTON, MA 02072
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen Borges, Vice President, Finance Operations
(508) 941-7571
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/13/2020
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