340B Drug Pricing Program Database
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MAXI DRUG, 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
MAXI DRUG, INC.
Pharmacy Address
RITE AID #10177
233 BROAD STREET
BRIDGEWATER, MA 02324
Pharmacy Comments
Contract Details
Approval Date
10/4/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/17/2018
Ownership change
Contacts
Covered Entity Signing Official
James N. Papadakos, Chief Financial Officer
(508) 941-7570
Contract Pharmacy Representative
Rite Aid
Alison Farrell, Vice President |Managed Care
(717) 975-5968
Signed By Date
10/4/2016
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