Covered Entity Details

DSH100012E LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL (Terminated) - information as of 6/2/2025 8:29:49 AM

Main Details

Name

LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL

Subdivision Name

LMHS PLANTATION OUTPATIENT CENTER

Type

Disproportionate Share Hospital

Rural

340B ID

DSH100012E

Medicare Provider Number

100012

Outpatient Facility Provider Number

Additional Details

Current Program Status

Terminated

Registration Date

3/5/2009

Participating Start Date

4/1/2009

Participating Approval Date

3/9/2009

Last Recertification Date

9/3/2019

Termination Date
Termination Reason

7/1/2020
Other

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

13601 PLANTATION ROAD
Suite 3
FORT MYERS, FL 33912

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
11/08-DOC RECD TO CONFIRM ELIG DSH ADJ%	03/05/2009

Medicaid Billing

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

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

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 HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center - CT Scan	9981 S. Healthpark Drive	Fort Myers	FL	Approved
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
DSH100012DY	Child	DSH	LEE HEALTH SYSTEM, INC. DBA LEE HEALTH	Healthpark Medical Center- Interventional Radiology - Interventional Radiology	9981 S. Healthpark Drive	FORT MYERS	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
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	State	Update		To Be Terminated	Terminated	7/1/2020 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		4/1/2017 12:00:00 AM	6/5/2020 7:33 AM
Details	State	Update	Termination Request	Active	To Be Terminated	6/5/2020 7:33 AM
Terminations	Termination Comments	Update	Termination Request		HRSA Audit finding- At the time of the HRSA audit in January 2020, we had failed to remove this outpatient facility after having registered clinics/departments/services within the facility. This registration is being terminated to remove a duplicate registration situation as instructed in audit findings.	6/5/2020 7:33 AM
Terminations	Termination Date	Update	Termination Request		7/1/2020 12:00:00 AM	6/5/2020 7:33 AM
Terminations	Termination Effective Date	Update	Termination Request		4/1/2017 12:00:00 AM	6/5/2020 7:33 AM
Terminations	Termination Reason	Update	Termination Request		Other	6/5/2020 7:33 AM
Details	Last Recertification Date	Update	Recertification	8/23/2018 6:43:26 AM	9/3/2019 4:46:21 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	8/23/2018 6:43 AM
Details	Last Recertification Date	Update	Recertification	12/1/2017 3:28:42 PM	8/23/2018 6:43:26 AM	8/23/2018 6:43 AM
Contacts	Primary Contact	Update	Change Request	Armitstead, John System Director Pharmacy Lee Health 2393436490	Bitner, Joseph Compliance Officer Lee Health 2393436426	1/3/2018 3:55 PM
Contacts	Primary Contact	Insert	Recertification		Armitstead, John System Director Pharmacy Lee Health 2393436490	12/1/2017 3:28 PM
Details	Last Recertification Date	Update	Recertification	8/10/2016 12:00:00 AM	12/1/2017 3:28:42 PM	12/1/2017 3:28 PM
Contacts	Authorizing Official	Update		Spence, Benjamin CFO 2393436014	Spence, Benjamin CFO Lee Memorial Health System 2393436014	9/27/2017 7:42 AM
Contacts	Authorizing Official	Update		WIEST, JOHN K. CHIEF OPERATING OFFICER - BUSINESS & STRATEGIC SERVICES 2394243542	Spence, Benjamin CFO 2393436014	8/14/2017 5:43 PM
Addresses	Main Address	Insert			13601 PLANTATION ROAD Suite 3 FORT MYERS, FL 33912	3/15/2017 11:35 AM
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 1:01:27 PM	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 1:01:27 PM	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				3/5/2009 2:38 PM
Details	Grant Number	Insert				3/5/2009 2:38 PM
Details	340B ID	Insert			DSH100012E	3/5/2009 2:38 PM
Details	Is Authorizing Official EHB Data	Insert				3/5/2009 2:38 PM
Dates	Last Date That 340B Drugs Purchased	Insert				3/5/2009 2:38 PM
Details	Medicare Provider Number	Insert			100012	3/5/2009 2:38 PM
Details	Entity Name	Insert			LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL	3/5/2009 2:38 PM
Details	Program Code	Insert			DSH	3/5/2009 2:38 PM
Details	Entity Subname	Insert			LMHS PLANTATION OUTPATIENT CENTER	3/5/2009 2:38 PM
Dates	Participating Approval Date	Insert			3/9/2009 12:00:00 AM	3/5/2009 2:38 PM
Details	State	Insert			Active	3/5/2009 2:38 PM
Dates	Registration Date	Insert			3/5/2009 12:00:00 AM	3/5/2009 2:38 PM
Dates	Signed By Date	Insert			1/23/2009 12:00:00 AM	3/5/2009 2:38 PM
Dates	Start Date	Insert			4/1/2009 12:00:00 AM	3/5/2009 2:38 PM
Terminations	Termination Comments	Insert				3/5/2009 2:38 PM
Terminations	Termination Date	Insert				3/5/2009 2:38 PM
Terminations	Termination Effective Date	Insert				3/5/2009 2:38 PM
Terminations	Termination Reason	Insert				3/5/2009 2:38 PM
Details	Comments Public	Insert			11/08-DOC RECD TO CONFIRM ELIG DSH ADJ%	3/5/2009 2:38 PM