Contract Pharmacy Details

WALGREEN EASTERN CO., INC.
DSH220052 BROCKTON HOSPITAL, INC

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

DBA: WALGREENS # 03758
610 PLEASANT ST.
BROCKTON, MA 02301-2513

Pharmacy Comments

Contract Details

Approval Date

4/13/2012

Contract Begin Date

4/13/2012

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Kim Hollon, President/CEO
(508) 941-7000

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

4/20/2012

340B Drug Pricing Program Database