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THE STOP & SHOP SUPERMARKET
DSH220074 SOUTHCOAST HOSPITALS GROUP, INC
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Covered Entity Details
Entity Name
SOUTHCOAST HOSPITALS GROUP, INC
Subdivision Name
DBA CHARLTON MEMORIAL HOSPITAL
Type
Disproportionate Share Hospital
340B ID
DSH220074
Entity Address
363 HIGHLAND AVENUE
FALL RIVER, MA 02720
Medicare Provider Number
220074
Participating Start Date
7/1/2004
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
THE STOP & SHOP SUPERMARKET
Pharmacy Address
DBA STOP & SHOP PHARMACY #493
25 FAUNCE CORNER ROAD
DARTMOUTH, MA 02747
Pharmacy Comments
Contract Details
Approval Date
4/7/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/3/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Renee Clark, Exec. Vice President & Chief Operating Officer
(508) 973-5872
Contract Pharmacy Representative
Stop and Shop
David Dunn, Pharmacy Operations Manager
(774) 644-1263
Signed By Date
4/7/2021
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