Covered Entity Details

DSH100012 LEE HEALTH SYSTEM, INC. DBA LEE HEALTH (Active) - information as of 4/23/2025 10:51:51 PM

Main Details

Name

LEE HEALTH SYSTEM, INC. DBA LEE HEALTH

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH100012

Medicare Provider Number

100012

Additional Details

Current Program Status

Active

Registration Date

12/3/2008

Participating Start Date

1/1/2009

Participating Approval Date

12/3/2008

Last Recertification Date

8/18/2024

Contacts

Authorizing Official

Lee Memorial Health System
Benjamin Spence, CFO
(239) 343-6014

Primary Contact

Lee Memorial Health System
Joseph Bitner, Compliance Officer
(239) 343-8602

Addresses

Street Address

2776 CLEVELAND AVENUE
FORT MYERS, FL 33901

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
9/09-DOC RECD TO CONFIRM ELIG DSH ADJ%	12/03/2008

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Leesar
2727 Winkler Ave.
Fort Myers, FL 33901

Shipping Address 2

Lee Memorial Hospital
2776 Cleveland Avenue
Fort Myers, FL 33901

Shipping Address 3

Lee Pharmacy 1
2776 Cleveland Ave
Fort Myers, FL 33901

Shipping Address 4

Lee Pharmacy 2
9981 S. Healthpark Drive
Fort Myers, FL 33908

Shipping Address 5

Lee Pharmacy 5
4751 S. Cleveland Ave.
Fort Myers, FL 33907

Shipping Address 6

Healthpark Medical Center
9981 South Healthpark Drive
Fort Myers, FL 33908

Shipping Address 7

Golisano Children's Hospital
9981 South Healthpark Drive
Building 2- Children's Hospital
Fort Myers, FL 33908

Shipping Address 8

Lee Pharmacy 7
23450 Via Coconut Point
Estero, FL 34135

Shipping Address 9

Lee Health Home Infusion
11220 Metro Parkway
Suite 31
Fort Myers, FL 33966

Shipping Address 10

Regional Cancer Center Pharmacy
8931 Colonial Center Drive
Fort Myers, FL 33905

Shipping Address 11

LeeSar
2727 Winkler Ave
Suite 100
Fort Myers, FL 33901

Shipping Address 12

Lee Pharmacy 7 (Community)
23450 Via Coconut Point
Suite 15637
Estero, FL 34135

Shipping Address 13

Lee Health Specialty Pharmacy
8350 Hospital Drive
Suite 120
Bonita Springs, FL 34135

Shipping Address 14

Lee Health Plan Pharmacy
2503 Del Prado Blvd. S.
Suite 504
Cape Coral, FL 33904

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	07/17/2018	10/01/2018		10/01/2018
Contract Detail	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	07/17/2018	10/01/2018		10/01/2018
Contract Detail	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	07/17/2018	10/01/2018		10/01/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/17/2018	10/01/2018		10/01/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	07/17/2018	10/01/2018		10/01/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	07/17/2018	10/01/2018	07/31/2023	10/16/2023
Contract Detail	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	07/17/2018	10/01/2018	07/19/2018	07/20/2018
Contract Detail	ACCREDO HEALTH GROUP, INC.	4750 E 450 S	SUITE A	WHITESTOWN	IN	46075	10/16/2023	01/01/2024		01/01/2024
Contract Detail	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	07/17/2018	10/01/2018	01/14/2020	01/14/2020
Contract Detail	AVELLA OF DEER VALLEY	23620 N 20TH DR #12		PHOENIX	AZ	85085-0621	07/15/2019	10/01/2019	10/01/2021	10/01/2021
Contract Detail	AVELLA OF ORLANDO	100 TECHNOLOGY PARK STE 155		LAKE MARY	FL	32746-6205	07/15/2019	10/01/2019	06/01/2020	06/15/2020
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	4900 PROSPECTUS DR STE 300		DURHAM	NC	27713	04/08/2024	07/01/2024		07/01/2024
Contract Detail	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	04/09/2024	07/01/2024		07/01/2024
Contract Detail	CAPE MEMORIAL HOSPITAL, INC	DBA: CAPE CORAL HOSPITAL	636 DEL PRADO BLVD S ATTN: PHARMACY DEPT	CAPE CORAL	FL	33990	07/01/2009	07/01/2009	03/24/2016	03/15/2017
Contract Detail	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	07/17/2018	10/01/2018		10/01/2018
Contract Detail	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	01/04/2020	04/01/2020		04/01/2020
Contract Detail	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	10/16/2017	01/01/2018	07/01/2024	07/01/2024
Contract Detail	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	07/15/2019	10/01/2019	06/14/2021	10/11/2023
Contract Detail	DIPLOMAT SPECIALTY PHARMACY OF FT LAUDER	DIPLOMAT SPECIALTY PHARMACY	15471 SW 12TH ST STE 207	SUNRISE	FL	33326	07/15/2019	10/01/2019	06/14/2021	10/11/2023
Contract Detail	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	07/17/2018	10/01/2018		10/01/2018
Contract Detail	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/05/2018	01/01/2019		01/01/2019
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	07/17/2018	10/01/2018		10/01/2018
Contract Detail	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	07/17/2018	10/01/2018		10/01/2018
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03274	9852 STRINGFELLOW RD	SAINT JAMES CITY	FL	33956	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03164	520 W SUGARLAND HWY	CLEWISTON	FL	33440	04/15/2020	05/14/2020	12/17/2024	12/20/2024
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03248	1102 N 15TH ST	IMMOKALEE	FL	34142	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03122	2480 TAMIAMI TRL	PORT CHARLOTTE	FL	33952	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03349	19070 S TAMIAMI TRAIL	FORT MYERS	FL	33908	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07983	11300 STATE ROAD 82	FORT MYERS	FL	33905	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03622	4100 HANCOCK BRIDGE PKWY	NORTH FORT MYERS	FL	33903	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03296	4710 PALM BEACH BLVD	FORT MYERS	FL	33905	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00196	15550 SAN CARLOS BLVD.	FORT MYERS	FL	33908	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05787	11500 BONITA BEACH RD. SE	BONITA SPRINGS	FL	34135	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07902	1611 PINE ISLAND RD NE	CAPE CORAL	FL	33909	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01067	737 CAPE CORAL PKWY E	CAPE CORAL	FL	33904	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00453	15050 N CLEVELAND AVE	NORTH FORT MYERS	FL	33903	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03941	2403 CLEVELAND AVE	FORT MYERS	FL	33901	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05041	5585 GOLDEN GATE PKWY	NAPLES	FL	34116	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 01807	1350 LEE BLVD	LEHIGH ACRES	FL	33936	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05785	1209 DEL PRADO BLVD., SOUTH	CAPE CORAL	FL	33990	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04224	1003 SANTA BARBARA BLVD	CAPE CORAL	FL	33991	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03433	14411 PALM BEACH BLVD	FORT MYERS	FL	33905	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05185	12255 S CLEVELAND AVE.	FORT MYERS	FL	33907	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 00406	2400 TAMIAMI TRL	PUNTA GORDA	FL	33950	04/15/2020	05/14/2020		05/14/2020
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 04608	24800 S TAMIAMI TRL	BONITA SPRINGS	FL	34134	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03616	13400 S CLEVELAND AVE	FORT MYERS	FL	33907	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03485	16950 PINE RIDGE RD.	FORT MYERS	FL	33908	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 02982	13591 JETPORT COMMERCE PKWY.	FORT MYERS	FL	33913	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07890	7581 WINKLER RD	FORT MYERS	FL	33908	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03441	2331 PALM RIDGE RD	SANIBEL	FL	33957	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05375	14240 TAMIAMI TRAIL NORTH	NAPLES	FL	34110	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17427	15880 SAN CARLOS BLVD	FT MYERS	FL	33908	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05236	9170 DANIELS PKWY	FORT MYERS	FL	33912	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03281	11241 MIROMAR SQUARE BLVD	ESTERO	FL	33928	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 16786	2430 SANTA BARBARA BLVD	CAPE CORAL	FL	33914	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17384	8040 MEDITERRANEAN DR	ESTERO	FL	33928	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17433	9350 DYNASTY DR	FT MYERS	FL	33905	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03277	5990 S POINTE BLVD	FORT MYERS	FL	33919	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	CVS PHARMACY # 17383	1890 NE PINE ISLAND ROAD	CAPE CORAL	FL	33909	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 03611	7001 ESTERO BLVD	FORT MYERS BEACH	FL	33931	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 07899	6800 COLLIER BLVD,	NAPLES	FL	34114	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 05116	16961 ALICO MISSION WAY	FORT MYERS	FL	33908	04/15/2021	07/01/2021		07/01/2021
Contract Detail	HOLIDAY CVS, L.L.C.	DBA: CVS/PHARMACY # 09996	6391 BAYSHORE RD.	NORTH FORT MYERS	FL	33917	04/15/2021	07/01/2021	12/17/2024	12/20/2024
Contract Detail	IOWA CVS PHARMACY, L.L.C.	CVS PHARMACY # 16894	1030 BLAIRS FERRY RD NE	CEDAR RAPIDS	IA	52402	04/15/2021	07/01/2021		07/01/2021
Contract Detail	LEE MEMORIAL HEALTH SYSTEM	D/B/A LEE HEALTH HOME INFUSION	11220 METRO PKWY STE 31 D/B/A LEE HEALTH HOME INFUSION	FORT MYERS	FL	33966-1291	07/13/2017	10/01/2017	04/06/2023	04/07/2023
Contract Detail	LEE MEMORIAL HEALTH SYSTEM	EMPLOYEE PHARMACY	636 DEL PRADO BLVD S SUTE 4 MOB	CAPE CORAL	FL	33990-2668	10/13/2017	01/01/2018	07/15/2022	07/15/2022
Contract Detail	LEE MEMORIAL HEALTH SYSTEM	LEE PHARMACY 7	23450 VIA COCONUT PT	ESTERO	FL	34135-1877	04/15/2020	05/14/2020	10/01/2020	10/01/2020
Contract Detail	NEW JERSEY CVS PHARMACY, L.L.C.	DBA: CVS/PHARMACY # 06947	819 BARNEGAT AVENUE	SHIP BOTTOM	NJ	08008	04/15/2021	07/01/2021		07/01/2021
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	07/15/2019	10/01/2019	08/31/2020	08/31/2020
Contract Detail	OPTUM FRONTIER THERAPIES II, LLC	6425 SANTA MARGARITA ST UNIT 110		LAS VEGAS	NV	89118-1913	07/16/2021	10/01/2021		10/01/2021
Contract Detail	OPTUM INFUSION SERVICES 201, INC.	5700 DOT COM CT STE 1030		OVIEDO	FL	32765-3400	07/16/2021	10/01/2021	04/20/2023	04/20/2023
Contract Detail	OPTUM INFUSION SERVICES 203 INC	9984 PREMIER PKWY		MIRAMAR	FL	33025-3209	07/15/2019	10/01/2019	04/08/2020	04/15/2020
Contract Detail	OPTUM INFUSION SERVICES 204, INC	4220 EXECUTIVE CIRCLE, SUITE 62		FORT MYERS	FL	33916	07/16/2021	10/01/2021	08/02/2022	10/11/2023
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	4000 CHEMICAL RD STE 100		PLYMOUTH MEETING	PA	19462	07/16/2021	10/01/2021		10/01/2021
Contract Detail	OPTUM INFUSION SERVICES 305, LLC	15529 COLLEGE BLVD.		LENEXA	KS	66219-1351	07/16/2021	10/01/2021		10/01/2021
Contract Detail	OPTUM INFUSION SERVICES 500, INC.	4900 RIVERGRADE RD STE E120		IRWINDALE	CA	91706-1419	07/16/2021	10/01/2021	10/02/2023	10/30/2023
Contract Detail	OPTUM INFUSION SERVICES 550, LLC	7167 E. KEMPER RD.		CINCINNATI	OH	45249	07/16/2021	10/01/2021		10/01/2021
Contract Detail	OPTUM PHARMACY 701, LLC	4100 S SAGINAW ST STE D		FLINT	MI	48507	04/11/2022	04/13/2022		04/19/2022
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/15/2019	10/01/2019		10/01/2019
Contract Detail	OPTUM PHARMACY 705, LLC	1100 LEE BRANCH LN		BIRMINGHAM	AL	35242-7298	07/15/2019	10/01/2019		10/01/2019
Contract Detail	OPTUM PHARMACY 706, INC.	30-30 47TH AVENUE	SUITE 410	LONG ISLAND CITY	NY	11101	07/15/2019	10/01/2019		10/01/2019
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/15/2019	10/01/2019		10/01/2019
Contract Detail	OPTUMRX	2858 LOKER AVE E STE 100		CARLSBAD	CA	92010-6608	04/15/2020	05/14/2020	05/27/2022	05/27/2022
Contract Detail	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	04/15/2020	05/14/2020		05/14/2020
Contract Detail	PENNSYLVANIA CVS PHARMACY, L.L.C.	CVS/PHARMACY # 11136	314 SOUTH 5TH STREET	PHILADELPHIA	PA	19106	04/15/2021	07/01/2021		07/01/2021
Contract Detail	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	10/16/2017	01/01/2018	10/01/2022	10/06/2022
Contract Detail	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	07/17/2018	10/01/2018		10/01/2018
Contract Detail	PUBLIX PHARMACY #0059	6900 DANIELS PKWY	STE 19	FORT MYERS	FL	33912	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX PHARMACY #0418	1616 CAPE CORAL PARKWAY W #5		CAPE CORAL	FL	33914	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX PHARMACY #0426	4600 SUMMERLIN ROAD		FT MYERS	FL	33919	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX PHARMACY #0452	SANTA BARBARA CENTRE	100 HANCOCK BRIDGE PARKWAY W.	CAPE CORAL	FL	33991	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX PHARMACY #0578	11600 GLADIOLUS DRIVE		FT MYERS	FL	33908	01/15/2019	04/01/2019	06/15/2021	06/15/2021
Contract Detail	PUBLIX PHARMACY #0614	21301 S TAMIAMI TRAIL SUITE 200		ESTERO	FL	33928	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX PHARMACY #1407	17960 N TAMIAMI TRAIL		NORTH FORT MYERS	FL	33903	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS	DBA PUBLIX PHARMACY #0683	5997 SOUTH POINTE BLVD SUITE 106	FT MYERS	FL	33919	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0864	13650 FIDDLESTICKS BOULEVARD	FORT MYERS	FL	33912	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0701	4065 HANCOCK BRIDGE PARKWAY	NORTH FT MYERS	FL	33903	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0162	5781 LEE BLVD	LEHIGH ACRES	FL	33971-6337	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #1302	13401 SUMMERLIN RD	FORT MYERS	FL	33919	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0157	19100 S TAMIAMI TR	FT MYERS	FL	33908	01/15/2019	04/01/2019	03/01/2021	03/01/2021
Contract Detail	PUBLIX SUPER MARKETS	PUBLIX PHARMACY #0775	15880 SUMMERLIN ROAD	FORT MYERS	FL	33908	01/15/2019	04/01/2019	06/15/2021	06/15/2021
Contract Detail	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0843	12900 TRADE WAY FOUR	BONITA SPRINGS	FL	34135	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0781	15265 COLLIER BLVD	NAPLES	FL	34119	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0847	20311 GRANDE OAKS SHOPPES BLVD	ESTERO	FL	33928	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0826	1631 DEL PRADO BLVD. SOUTH	CAPE CORAL	FL	33990	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS INC	PUBLIX PHARMACY #0854	2420 SANTA BARBARA BOULEVARD	CAPE CORAL	FL	33914	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1527	13550 IMMOKALEE RD	NAPLES	FL	34120	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1262	16980 ALICO MISSION WAY SUITE 403	FORT MYERS	FL	33908	01/15/2019	04/01/2019	06/15/2021	06/15/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY # 1156	2160 MCGREGOR BLVD.	FORT MYERS	FL	33901	01/15/2019	04/01/2019	06/15/2021	06/15/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1557	3941 TAMIAMI TRAIL UNIT 3145	PUNTA GORDA	FL	33950	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1325	26841 SOUTH TAMIAMI TRAIL	BONITA SPRINGS	FL	34134	01/15/2019	04/01/2019	06/15/2021	06/15/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1147	2481 DEL PRADO BLVD. NORTH	CAPE CORAL	FL	33909	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1328	1735 N.E. PINE ISLAND RD	CAPE CORAL	FL	33909	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1280	7950 DANI DR. SUITE 200	FORT MYERS	FL	33966	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #3213	1950 SAND LAKE RD, BLDG #5	ORLANDO	FL	32809	01/15/2019	04/01/2019	06/15/2021	06/15/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1039	11851 PALM BEACH BOULEVARD	FORT MYERS	FL	33905	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #0604	24600 S TAMIAMI TRL STE 300	BONITA SPRINGS	FL	34134	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1327	127 CAPE CORAL PKWY WEST	CAPE CORAL	FL	33914	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1352	6700 BAYSHORE RD.	NORTH FORT MYERS	FL	33917	01/15/2019	04/01/2019	02/05/2021	02/27/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1443	1324 HOMESTEAD RD. NORTH	LEHIGH ACRES	FL	33936	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1564	13121 PAUL J. DOHERTY PKWY	FORT MYERS	FL	33913	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX CENTRAL PHARMACY #3201	2424 ORLANDO CENTRAL PARKWAY	ORLANDO	FL	32809	01/15/2019	04/01/2019	06/15/2021	06/15/2021
Contract Detail	PUBLIX SUPER MARKETS, INC.	PUBLIX PHARMACY #1007	3015 PINE ISLAND ROAD S.W.	CAPE CORAL	FL	33991	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	PUBLIX SUPERMARKETS, INC.	PUBLIX PHARMACY #1449	3304 BONITA BEACH ROAD	BONITA SPRINGS	FL	34134	01/15/2019	04/01/2019	03/05/2021	03/05/2021
Contract Detail	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-0623	545 PINE ISLAND ROAD		NORTH FORT MYERS	FL	33903	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-0819	1619 DEL PRADO BLVD		CAPE CORAL	FL	33990	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-0987	14821 SIX MILE CYPRESS PKWY		FORT MYERS	FL	33912	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-2237	2523 LEE BLVD		LEHIGH ACRES	FL	33971	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-5034	4770 COLONIAL BLVD		FT MYERS	FL	33912	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-5321	9131 COLLEGE PARKWAY		FORT MYERS	FL	33919	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-5451	3920 SKYLINE BLVD.		CAPE CORAL (S)	FL	33914	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-5453	505 PINE ISLAND ROAD SW		CAPE CORAL	FL	33991	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WALGREEN CO	DBA: WALGREENS #09298	21950 SOUTH TAMIAMI TRAIL	ESTERO	FL	33928	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #09627	12041 PALM BEACH BLVD	FORT MYERS	FL	33905	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #10179	6370 BAYSHORE RD	NORTH FORT MYERS	FL	33917-3137	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #10964	10672 COLONIAL BLVD	FORT MYERS	FL	33913	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO	DBA: WALGREENS #10668	2575 NE HWY 70	ARCADIA	FL	34266	10/16/2017	01/01/2018	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02941	3593 CLEVELAND AVE	FT MYERS	FL	33901-7975	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	WALGREEN #03099	1525 COLONIAL BLVD.	FORT MYERS	FL	33907	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03355	6 DEL PRADO BLVD N	CAPE CORAL	FL	33909	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03356	15601 SAN CARLOS BLVD	FT MYERS	FL	33908	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03628	4204 PALM BEACH BLVD.	FT MYERS	FL	33905	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03753	2710 DEL PRADO BLVD. SOUTH	CAPE CORAL	FL	33904	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04004	12749 S. CLEVELAND AVENUE	FT MYERS	FL	33907	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04165	28100 S. TAMIAMI TRAIL	BONITA SPRINGS	FL	34134	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04645	1534 CAPE CORAL PARKWAY W	CAPE CORAL	FL	33914	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05693	1450 IMMOKALEE DRIVE	IMMOKALEE	FL	34142	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05856	4 NE PINE ISLAND RD	CAPE CORAL	FL	33909	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06071	38 HOMESTEAD RD N	LEHIGH ACRES	FL	33936-6646	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06473	13551 MCGREGOR BLVD	FT MYERS	FL	33919	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06499	25091 S TAMIAMI TRL	BONITA SPRINGS	FL	34134	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06913	15900 SUMMERLIN ROAD	FT MYERS	FL	33908-3605	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07028	1606 DEL PRADO BLVD S	CAPE CORAL	FL	33990-3798	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07029	2409 SANTA BARBARA BLVD	CAPE CORAL	FL	33914	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07078	1405 E VENICE AVE	VENICE	FL	34292-3064	10/16/2017	01/01/2018	10/01/2021	10/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07085	6790 DANIELS PARKWAY	FT MYERS	FL	33912	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07465	16000 N CLEVELAND AVE	NORTH FT MYERS	FL	33903-2107	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09219	17065 PINE RIDGE RD	FORT MYERS BEACH	FL	33931	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10670	17970 N TAMIAMI TRAIL	NORTH FORT MYERS	FL	33903	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #10829	611 BURNT STORE RD S	CAPE CORAL	FL	33991	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11535	3501 UNIQUE CIRCLE	FORT MYERS	FL	33908	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12722	9150 KINGS CROSSING RD	FORT MYERS	FL	33912	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS #15136	805 CAPE CORAL PKY E	CAPE CORAL	FL	33904	10/16/2017	01/01/2018		10/16/2017
Contract Detail	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #15106	1250 NW 7TH STREET SUITE 205	MIAMI	FL	33125	10/16/2017	01/01/2018	09/14/2021	10/16/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13578	1921 WALDEMERE ST STE 201	SARASOTA	FL	34239	07/14/2019	10/01/2019	10/01/2021	10/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #12146	1200 KUHL AVE	ORLANDO	FL	32806	07/14/2019	10/01/2019	10/01/2021	10/01/2021
Contract Detail	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13072	8333 N DAVIS HWY STE 50	PENSACOLA	FL	32514	01/14/2020	04/01/2020	10/01/2021	10/01/2021
Contract Detail	WALGREEN CO.	DBA: WALGREENS SPECIALTY PHARMACY #12146	1200 KUHL AVE	ORLANDO	FL	32806	10/04/2021	10/04/2021	07/01/2024	07/01/2024
Contract Detail	WALGREEN CO.	DBA: WALGREENS #11658	4747 GOLDEN GATE PKWY	NAPLES	FL	34116	01/06/2022	04/01/2022	07/01/2024	07/01/2024
Contract Detail	Walgreens #21395	Walgreens Central Fill #21395	5710 Young Pine Rd	Orlando	FL	32829	10/18/2022	01/01/2023		01/01/2023
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	10/16/2017	01/01/2018	07/01/2024	07/01/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	10/16/2017	01/01/2018	10/01/2021	10/04/2021
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	10/16/2017	01/01/2018	07/01/2024	07/01/2024
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	10/16/2017	01/01/2018	07/01/2024	07/01/2024
Contract Detail	WALMART PHARMACY #10-6190	1951 W HICKPOCHEE AVE		LABELLE	FL	33935	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WALMART PHARMACY #10-6941	2020 NE PINE ISLAND ROAD		CAPE CORAL	FL	33909	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WALMART PHARMACY 10-4063	17105 SAN CARLOS BLVD		FT MYERS BEACH	FL	33931	10/15/2018	01/01/2019	07/15/2021	07/15/2021
Contract Detail	WALMART PHARMACY 10-5347	19975 S TAMIAMI TRAIL		ESTERO	FL	33928	10/15/2018	01/01/2019	07/15/2021	07/15/2021

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH100012A	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	HEALTHPARK MEDICAL CENTER	9981 S. HEALTH PARK DRIVE	FORT MYERS	FL	Terminated
DSH100012AA	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - Cardiac Catheterization	9981 S. Healthpark Drive	Fort Myers	FL	Approved
DSH100012AB	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Golisano Children's Hospital - Outpatient surgery PACU	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012AC	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - Outpatient Surgery	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012AD	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - Endoscopy	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012AE	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	The Sanctuary Outpatient Surgery Center - Surgery	8970 Colonial Center Drive	Fort Myers	FL	Active
DSH100012AF	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	THE OUTPATIENT CENTER AT HEALTHPARK COMMONS - Asthma/COPD Management	16281 Bass Road	Fort Myers	FL	Terminated
DSH100012AG	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	THE OUTPATIENT CENTER AT HEALTHPARK COMMONS - Radiology Services	16281 Bass Road	Fort Myers	FL	Terminated
DSH100012AH	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	THE OUTPATIENT CENTER AT HEALTHPARK COMMONS - Womens Breast Center	16281 Bass Road	Fort Myers	FL	Terminated
DSH100012AJ	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	PLANTATION OUTPATIENT CENTER - Sleep Study Clinic	13601 Plantation Rd.	Fort Myers	FL	Terminated
DSH100012AK	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	THE OUTPATIENT CENTER AT HEALTHPARK COMMONS - Rehabilitation Services	16281 Bass Road	Fort Myers	FL	Terminated
DSH100012AL	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PLANTATION OUTPATIENT CENTER - ALS Clinic	13601 Plantation Rd.	Fort Myers	FL	Active
DSH100012AM	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	THE SANCTUARY OUTPATIENT CENTER - Rehabilitation Services	8960 Colonial Center Drive	Fort Myers	FL	Terminated
DSH100012AN	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	THE OUTPATIENT CENTER AT HEALTHPARK COMMONS - Pulmonary Function Diagnostics	16281 Bass Road	Fort Myers	FL	Terminated
DSH100012AP	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	THE SANCTUARY OUTPATIENT CENTER - Pain/Spine Clinic	8960 Colonial Center Drive	Fort Myers	FL	Active
DSH100012AQ	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS Plantation Outpatient Center - Asthma/COPD Management	13601 Plantation Road	Fort Myers	FL	Terminated
DSH100012AR	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH AT COCONUT POINT - Outpatient Diabetes Clinic	23450 VIA COCONUT POINT	ESTERO	FL	Terminated
DSH100012AS	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Outpatient Diabetes Clinic	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012AT	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - CT Scan	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012AU	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH AT COCONUT POINT - Women's Breast Center	23450 VIA COCONUT POINT	ESTERO	FL	Terminated
DSH100012AV	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS PEDIATRIC REHAB CENTER - Pediatric Orthopedic Rehab	15821 HOLLYFERN COURT	FORT MYERS	FL	Terminated
DSH100012AW	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Golisano Children's Hospital - Rehab Services	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012AX	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Golisano Children's Hospital - Neuroscience	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012AY	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH AT COCONUT POINT - MRI	23450 VIA COCONUT POINT	ESTERO	FL	Terminated
DSH100012AZ	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Neuroscience	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012B	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	THE OUTPATIENT CENTER AT HEALTHPARK COMMONS	16281 BASS ROAD	FORT MYERS	FL	Terminated
DSH100012BA	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS Naples Childrens Health Center - Diagnostic Radiology	3361 Pine Ridge Road	Naples	FL	Terminated
DSH100012BB	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH AT COCONUT POINT - Diagnostic Radiology	23450 VIA COCONUT POINT	ESTERO	FL	Terminated
DSH100012BC	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH AT COCONUT POINT - Cardiac Rehab	23450 VIA COCONUT POINT	ESTERO	FL	Terminated
DSH100012BD	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Renal Dialysis	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012BE	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Golisano Children's Hospital - Dialysis	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012BF	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	LEE HEALTH AT COCONUT POINT - Emergency Services	23450 VIA COCONUT POINT	ESTERO	FL	Active
DSH100012BG	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	LMHS OP METRO CARDIOLOGY - Cardiovascular services	13340 METRO PARKWAY	FORT MYERS	FL	Active
DSH100012BH	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS BONITA BAY CENTER - Rehab Services	26800 SOUTH TAMIAMI TRAIL	BONITA SPRINGS	FL	Terminated
DSH100012BJ	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Rehab Services	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012BK	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	The Outpatient Center at Healthpark Commons - Pediatric Cardiovascular Services	16281 Bass Road	Fort Myers	FL	Terminated
DSH100012BL	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH AT COCONUT POINT - Rehab Services	23450 VIA COCONUT POINT	ESTERO	FL	Terminated
DSH100012BM	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS SANCTUARY OUTPATIENT CENTER - Outpatient Diabetes Clinic	8960 COLONIAL CENTER DRIVE	FORT MYERS	FL	Terminated
DSH100012BN	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS Sanctuary Outpatient Center - Women's Breast Center	8960 Colonial Center Drive	Fort Myers	FL	Terminated
DSH100012BP	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	LMHS Naples Childrens Health Center - Urgent Care Center	3361 Pine Ridge Road	Naples	FL	Active
DSH100012BQ	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS Naples Childrens Health Center - Rehab Services	3461 Pine Ridge Road	Naples	FL	Terminated
DSH100012BR	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Golisano Children's Hospital - Respiratory Care	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012BS	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	LEE HEALTH AT COCONUT POINT - Surgery Center	23450 VIA COCONUT POINT	ESTERO	FL	Active
DSH100012BT	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH AT COCONUT POINT - Respiratory Care	23450 VIA COCONUT POINT	ESTERO	FL	Terminated
DSH100012BU	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Diagnostic Radiology	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012BV	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Respiratory Care	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012BW	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Pulmonary Diagnostic Lab	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012BX	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH AT COCONUT POINT - CT Scan	23450 VIA COCONUT POINT	ESTERO	FL	Terminated
DSH100012BY	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Sleep Lab	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012BZ	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	LEE HEALTH AT COCONUT POINT - Cardiovascular	23450 VIA COCONUT POINT	ESTERO	FL	Active
DSH100012C	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	REGIONAL CANCER CENTER	8931 COLONIAL CENTER DRIVE	FORT MYERS	FL	Active
DSH100012CA	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS NAPLES CHILDRENS REHAB - Rehab Services	5450 YMCA RD	NAPLES	FL	Terminated
DSH100012CB	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Women and Children's Medical Plaza - Physical Therapy	15901 Bass Road	Fort Myers	FL	Terminated
DSH100012CC	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	LMHS Naples Childrens Health Center - Pediatric Hematology/Oncology	3361 Pine Ridge Rd	Naples	FL	Active
DSH100012CD	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Regional Cancer Center - Radiology- PET SCAN	8931 Colonial Center Drive	Fort Myers	FL	Active
DSH100012CE	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	REGIONAL CANCER CENTER AT BHC - Bonita Health Center Outpatient Cancer Treatment	3501 HEALTH CENTER BLVD, STE 1127	ESTERO	FL	Active
DSH100012CF	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS CCH HOD - Pediatrics	650 DEL PRADO BLVD S	CAPE CORAL	FL	Active
DSH100012CG	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	CARDIOLOGY SA HOD - Cardiology	8960 COLONIAL CENTER DR	FORT MYERS	FL	Active
DSH100012CH	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS CARDIOLOGY BR HOD - Pediatric Cardiology	16281 BASS RD	FORT MYERS	FL	Active
DSH100012CJ	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS PAGE FIELD HOD - Pediatrics	4751 S CLEVELAND AVE	FORT MYERS	FL	Active
DSH100012CK	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PULM CLAYTON CRT HOD - Pulmonology	5216 CLAYTON CT	FORT MYERS	FL	Active
DSH100012CL	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	GASTRO MPO HOD - Gastroenterology	9800 S HEALTHPARK DR	FORT MYERS	FL	Active
DSH100012CM	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	RHEUM SA HOD - Rheumatology	8960 COLONIAL CENTER DR	FORT MYERS	FL	Active
DSH100012CN	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS LEHIGH HOD - Pediatrics	260 BETH STACEY BLVD	LEHIGH ACRES	FL	Active
DSH100012CP	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS BEH HLTH WCMP HOD - Pediatric Behavioral Health	15901 BASS RD	FORT MYERS	FL	Active
DSH100012CQ	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS ENDO WCMP HOD - Pediatric Endocrinology	15901 BASS RD	FORT MYERS	FL	Active
DSH100012CR	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS NEURO WCMP HOD - Pediatric Neurology	15901 BASS RD	FORT MYERS	FL	Active
DSH100012CS	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS DEVELOP WCMP HOD - Pediatric Developmental Behavior	15901 BASS RD	FORT MYERS	FL	Active
DSH100012CT	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS NEO DEV WCMP HOD - Pediatric/Neonatal Developmental Care	15901 BASS RD	FORT MYERS	FL	Active
DSH100012CU	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS NEPH WCMP HOD - Pediatric Nephrology	15901 BASS RD	FORT MYERS	FL	Active
DSH100012CV	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS GENETIC SUMRL HOD - Pediatric Genetics	16230 SUMMERLIN RD	FORT MYERS	FL	Active
DSH100012CW	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS SURGERY SUMRL HOD - Pediatric Surgery	16230 SUMMERLIN RD	FORT MYERS	FL	Active
DSH100012CX	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS UROLOGY SUMRL HOD - Pediatric Urology	16230 SUMMERLIN RD	FORT MYERS	FL	Active
DSH100012CY	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS LHCP HOD - Pediatrics	23450 VIA COCONUT PT	ESTERO	FL	Active
DSH100012CZ	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	ADDICTION MED NB HOD - Addiction Medicine	12550 NEW BRITTANY BLVD	FORT MYERS	FL	Active
DSH100012D	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	THE SANCTUARY OUTPATIENT CENTER	8960 COLONIAL CENTER DRIVE	FORT MYERS	FL	Terminated
DSH100012DA	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	BEH HEALTH AMB NB HOD - Adult Behavioral Health	12550 NEW BRITTANY BLVD	FORT MYERS	FL	Active
DSH100012DB	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	NEURO RW HOD - Adult Neurology	12600 CREEKSIDE LN	FORT MYERS	FL	Active
DSH100012DC	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	UROLOGY WHITEHALL HOD - Adult Urology	12651 WHITEHALL DR	FORT MYERS	FL	Active
DSH100012DD	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	IM MATTHEW DR HOD - Internal Medicine	1569 MATTHEW DR	FORT MYERS	FL	Active
DSH100012DE	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	FM LABELLE HOD - Family Medicine	930 S MAIN ST	LABELLE	FL	Active
DSH100012DF	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	FM CAPE CORAL HOD - Family Medicine	1435 SE 8TH TER	CAPE CORAL	FL	Active
DSH100012DG	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	FM CLAYTON CRT HOD - Family Medicine	5225 CLAYTON CT	FORT MYERS	FL	Active
DSH100012DH	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	FM NORTH FORT MYERS HOD - Family Medicine	13279 N CLEVELAND AVE	NORTH FORT MYERS	FL	Active
DSH100012DJ	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	FM COLONIAL HOD - Family Medicine	8960 COLONIAL CENTER DR	FORT MYERS	FL	Active
DSH100012DK	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	FM LEHIGH HOD - Family Medicine	5705 LEE BLVD	LEHIGH ACRES	FL	Active
DSH100012DL	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	FM DUNBAR MLK HOD - Family Medicine	3637 DR MARTIN LUTHER KING BLVD	FORT MYERS	FL	Active
DSH100012DM	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	HEM ONC SACC HOD - Hematology/Oncology	8931 COLONIAL CENTER DR	FORT MYERS	FL	Active
DSH100012DN	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	CARDIOLOGY CCH HOD - Cardiology	708 DEL PRADO BLVD S	CAPE CORAL	FL	Active
DSH100012DP	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	ENDO SA HOD - Endocrinology	8960 COLONIAL CENTER DR	FORT MYERS	FL	Active
DSH100012DQ	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	PEDS GASTRO SUMRL HOD - Pediatric Gastroenterology	16230 SUMMERLIN RD	FORT MYERS	FL	Active
DSH100012DR	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	OB GYN LABELLE HOD - OB/GYN	930 S MAIN ST	LABELLE	FL	Approved
DSH100012DS	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	OB GYN LEHIGH HOD - OB/GYN	5705 LEE BLVD	LEHIGH ACRES	FL	Approved
DSH100012DT	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	OB GYN WCMP HOD - OB/GYN	15901 BASS RD	FORT MYERS	FL	Approved
DSH100012DU	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	ID LMH HOD - Infectious Disease	2780 CLEVELAND AVE	FORT MYERS	FL	Approved
DSH100012DV	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	OB GYN EFM HOD - OB/GYN	4040 PALM BEACH BLVD	FORT MYERS	FL	Approved
DSH100012DW	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	OB GYN MPO HOD - OB/GYN	9800 S HEALTHPARK DR	FORT MYERS	FL	Approved
DSH100012DX	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	ID CAPE CORAL HOD - Infectious Disease	1435 SE 8TH TER	CAPE CORAL	FL	Approved
DSH100012E	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LMHS PLANTATION OUTPATIENT CENTER	13601 PLANTATION ROAD	FORT MYERS	FL	Terminated
DSH100012F	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	ACCESS INFUSION	11220-31 METRO PARKWAY	FORT MYERS	FL	Terminated
DSH100012G	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	THE OUTPATIENT CENTER AT HEALTHPARK COMMONS	16281 Bass Road	Fort Myers	FL	Active
DSH100012H	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Wound Center	13778 Plantation Rd.	Fort Myers	FL	Active
DSH100012J	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Lee Behavioral Health Outpatient Center	12550 New Brittany Blvd	Ft. Myers	FL	Terminated
DSH100012M	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Lee Cardiology - Med Plaza One	9800S Healthpark Drive	Fort Myers	FL	Active
DSH100012N	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Lee Cardiology Bass Road	16261 Bass Road	Fort Myers	FL	Active
DSH100012P	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	PLANTATION OUTPATIENT CENTER / Outpatient Neuroscience	13601 Plantation Rd.	Fort Myers	FL	Terminated
DSH100012Q	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Golisano Children's Hospital - Pediatrics	9981 S. HealthPark Drive	Fort Myers	FL	Terminated
DSH100012R	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - Outpatient Anesthesia	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012S	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Healthpark Medical Center - Cardiovascular Stress Lab	9981 S. Healthpark Drive	Fort Myers	FL	Terminated
DSH100012T	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - Emergency Department	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012U	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - OB Emergency Department	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012V	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Golisano Children's Hospital - Pediatric Outpatient Oncology	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012W	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - Cardiac Observation	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012X	Child	DSH	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	Golisano Children's Hospital - Cardiovascular Stress Lab	9981 S. Healthpark Dr	Fort Myers	FL	Terminated
DSH100012Y	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Golisano Children's Hospital - Emergency Department	9981 S. Healthpark Drive	Fort Myers	FL	Active
DSH100012Z	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - Outpatient PACU	9981 S. Healthpark Drive	Fort Myers	FL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Addresses	Shipping Address	Delete	Change Request	Lee Memorial Health System Employee Pharmacy 636 Del Prado Blvd S. Suite 4 MOB Cape Coral, FL 33990		3/24/2025 12:19 PM
Addresses	Shipping Address	Insert	Change Request		Lee Health Plan Pharmacy 2503 Del Prado Blvd. S. Suite 504 Cape Coral, FL 33904	2/26/2025 12:12 PM
Details	Entity Name	Update	Change Request	LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	1/13/2025 2:31 PM
Addresses	Shipping Address	Delete	Change Request	Lee Pharmacy 5 4751 S Cleveland Ave Fort Myers, FL 33907		11/29/2024 8:43 AM
Addresses	Shipping Address	Insert	Change Request		Lee Pharmacy 5 4751 S Cleveland Ave Fort Myers, FL 33907	11/5/2024 12:56 PM
Addresses	Shipping Address	Insert	Change Request		Lee Health Specialty Pharmacy 8350 Hospital Drive Suite 120 Bonita Springs, FL 34135	11/5/2024 12:56 PM
Addresses	Shipping Address	Insert	Change Request		Lee Pharmacy 7 (Community) 23450 Via Coconut Point Suite 15637 Estero, FL 34135	10/7/2024 10:32 AM
Details	Last Recertification Date	Update	Recertification	8/29/2023 2:30:38 PM	8/18/2024 8:50:30 PM	8/18/2024 8:50 PM
Addresses	Shipping Address	Delete	Change Request	LeeSar, Inc 7455 16th St E Unit 107 Sarasota, FL 34243		11/17/2023 12:15 PM
Addresses	Shipping Address	Update	Change Request	LeeSar 2727 Winkler Ave Unit 100 Fort Myers, FL 33901	LeeSar 2727 Winkler Ave Suite 100 Fort Myers, FL 33901	9/11/2023 11:20 AM
Details	Last Recertification Date	Update	Recertification	8/25/2022 10:04:49 AM	8/29/2023 2:30:38 PM	8/29/2023 2:30 PM
Addresses	Shipping Address	Insert	Change Request		LeeSar 2727 Winkler Ave Unit 100 Fort Myers, FL 33901	8/17/2023 12:10 PM
Addresses	Shipping Address	Insert	Change Request		Regional Cancer Center Pharmacy 8931 Colonial Center Drive Fort Myers, FL 33905	4/19/2023 7:52 AM
Addresses	Shipping Address	Insert	Change Request		Lee Health Home Infusion 11220 Metro Parkway Suite 31 Fort Myers, FL 33966	4/7/2023 10:44 AM
Contacts	Primary Contact	Update	Profile Change Request	Bitner, Joseph Compliance Officer Lee Memorial Health System 2393436426	Bitner, Joseph Compliance Officer Lee Memorial Health System 2393438602	9/6/2022 11:16 AM
Details	Last Recertification Date	Update	Recertification	8/23/2021 11:09:34 AM	8/25/2022 10:04:49 AM	8/25/2022 10:04 AM
Addresses	Shipping Address	Insert	Change Request		Lee Memorial Health System Employee Pharmacy 636 Del Prado Blvd S. Suite 4 MOB Cape Coral, FL 33990	5/9/2022 7:06 AM
Details	Last Recertification Date	Update	Recertification	8/19/2020 12:51:10 PM	8/23/2021 11:09:34 AM	8/23/2021 11:09 AM
Details	Last Recertification Date	Update	Recertification	9/3/2019 4:46:39 PM	8/19/2020 12:51:10 PM	8/19/2020 12:51 PM
Addresses	Shipping Address	Delete	Change Request	Lee Pharmacy 7 23450 Via Coconut Point Estero, FL 33958		7/21/2020 8:07 AM
Addresses	Shipping Address	Insert	Change Request		Lee Pharmacy 7 23450 Via Coconut Point Estero, FL 34135	7/21/2020 8:07 AM
Addresses	Shipping Address	Insert	Change Request		Healthpark Medical Center 9981 South Healthpark Drive Fort Myers, FL 33908	6/18/2020 8:55 AM
Addresses	Shipping Address	Insert	Change Request		Golisano Children's Hospital 9981 South Healthpark Drive Building 2- Children's Hospital Fort Myers, FL 33908	6/18/2020 8:55 AM
Addresses	Shipping Address	Insert	Change Request		Lee Pharmacy 5 4751 S. Cleveland Ave. Fort Myers, FL 33907	6/16/2020 6:41 AM
Addresses	Shipping Address	Insert	Change Request		LeeSar, Inc 7455 16th St E Unit 107 Sarasota, FL 34243	6/9/2020 7:23 AM
Addresses	Shipping Address	Insert	Change Request		Lee Pharmacy 7 23450 Via Coconut Point Estero, FL 33958	4/17/2020 7:13 PM
Details	Last Recertification Date	Update	Recertification	8/17/2018 7:04:59 AM	9/3/2019 4:46:39 PM	9/3/2019 4:46 PM
Contacts	Primary Contact	Update	Recertification	Bitner, Joseph Compliance Officer Lee Health 2393436426	Bitner, Joseph Compliance Officer Lee Memorial Health System 2393436426	8/17/2018 7:04 AM
Details	Last Recertification Date	Update	Recertification	12/1/2017 3:37:24 PM	8/17/2018 7:04:59 AM	8/17/2018 7:04 AM
Addresses	Shipping Address	Insert	Change Request		Lee Pharmacy 1 2776 Cleveland Ave Fort Myers, FL 33901	3/13/2018 5:52 PM
Addresses	Shipping Address	Insert	Change Request		Lee Pharmacy 2 9981 S. Healthpark Drive Fort Myers, FL 33908	3/13/2018 5:52 PM
Contacts	Primary Contact	Update	Change Request	Armitstead, John System Director Pharmacy Lee Health 2393436490	Bitner, Joseph Compliance Officer Lee Health 2393436426	1/3/2018 3:47 PM
Contacts	Primary Contact	Update	Recertification	Spence, Benjamin CFO 2393436014	Armitstead, John System Director Pharmacy Lee Health 2393436490	12/1/2017 3:37 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	12/1/2017 3:37:24 PM	12/1/2017 3:37 PM
Contacts	Authorizing Official	Update		Spence, Benjamin CFO 2393436014	Spence, Benjamin CFO Lee Memorial Health System 2393436014	9/27/2017 7:42 AM
Addresses	Main Address	Insert			2776 CLEVELAND AVENUE FORT MYERS, FL 33901	8/14/2017 5:43 PM
Addresses	Shipping Address	Insert			Leesar 2727 Winkler Ave. Fort Myers, FL 33901	8/14/2017 5:43 PM
Addresses	Shipping Address	Insert			Lee Memorial Hospital 2776 Cleveland Avenue Fort Myers, FL 33901	8/14/2017 5:43 PM
Contacts	Authorizing Official	Update		WIEST, JOHN K. CHIEF OPERATING OFFICER - BUSINESS & STRATEGIC SERVICES 2394243542	Spence, Benjamin CFO 2393436014	8/14/2017 5:43 PM
Contacts	Primary Contact	Insert			Spence, Benjamin CFO 2393436014	8/14/2017 5:43 PM
Details	Last Recertification Date	Update		8/5/2015 12:00:00 AM	8/10/2016 12:00:00 AM	8/10/2016 1:41 PM
Details	Last Recertification Date	Update		8/6/2014 12:00:00 AM	8/5/2015 12:00:00 AM	8/5/2015 2:23 PM
Details	Last Recertification Date	Update		8/20/2013 12:00:00 AM	8/6/2014 12:00:00 AM	8/6/2014 9:44 AM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/20/2013 12:00:00 AM	8/20/2013 1:01 PM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 10:02 AM
Contacts	Authorizing Official	Insert			WIEST, JOHN K. CHIEF OPERATING OFFICER - BUSINESS & STRATEGIC SERVICES 2394243542	4/1/2011 10:57 AM
Details	Last Recertification Date	Insert				12/3/2008 3:38 PM
Details	Grant Number	Insert				12/3/2008 3:38 PM
Details	340B ID	Insert			DSH100012	12/3/2008 3:38 PM
Details	Is Authorizing Official EHB Data	Insert				12/3/2008 3:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert				12/3/2008 3:38 PM
Details	Medicare Provider Number	Insert			100012	12/3/2008 3:38 PM
Details	Entity Name	Insert			LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	12/3/2008 3:38 PM
Details	Program Code	Insert			DSH	12/3/2008 3:38 PM
Details	Entity Subname	Insert				12/3/2008 3:38 PM
Dates	Participating Approval Date	Insert			12/3/2008 12:00:00 AM	12/3/2008 3:38 PM
Details	State	Insert			Active	12/3/2008 3:38 PM
Dates	Registration Date	Insert			12/3/2008 12:00:00 AM	12/3/2008 3:38 PM
Dates	Signed By Date	Insert			11/24/2008 12:00:00 AM	12/3/2008 3:38 PM
Dates	Start Date	Insert			1/1/2009 12:00:00 AM	12/3/2008 3:38 PM
Terminations	Termination Comments	Insert				12/3/2008 3:38 PM
Terminations	Termination Date	Insert				12/3/2008 3:38 PM
Terminations	Termination Effective Date	Insert				12/3/2008 3:38 PM
Terminations	Termination Reason	Insert				12/3/2008 3:38 PM
Details	Comments Public	Insert			9/09-DOC RECD TO CONFIRM ELIG DSH ADJ%	12/3/2008 3:38 PM