Contract Pharmacy Details

CVS PHARMACY, 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

CVS PHARMACY, INC.

Pharmacy Address

DBA: CVS/PHARMACY # 00861
355 CENTRE ST.
BROCKTON, MA 02302

Pharmacy Comments

Contract Details

Approval Date

1/29/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

James N. Papadakos, Chief Financial Officer
(508) 941-7570

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

1/29/2016

340B Drug Pricing Program Database