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DUVALS 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
DUVALS PHARMACY, INC
Pharmacy Address
571 WASHINGTON ST
PO BOX 429
WHITMAN, MA 02382
Pharmacy Comments
Contract Details
Approval Date
10/14/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James N. Papadakos, Chief Financial Officer
(508) 941-7570
Contract Pharmacy Representative
John Duval, Owner
(781) 447-0606
Signed By Date
10/14/2014
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