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FQHCLA335 LEE MEMORIAL HEALTH SYSTEM (Terminated)
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Main Details
Name
LEE MEMORIAL HEALTH SYSTEM
Subdivision Name
North Fort Myers Medical Office
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-014712
340B ID
FQHCLA335
Grant Number
LALCS00171
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2015
Participating Start Date
7/1/2015
Participating Approval Date
4/22/2015
Last Recertification Date
1/29/2024
Termination Date
Termination Reason
1/1/2025
Business decision by the Covered Entity
Contacts
Authorizing Official
Lee Health
Rachel Suzanne Walter, System Director, FQHC-LA
(239) 823-5840
Primary Contact
Lee Health
Joseph Bitner, Compliance Officer
(239) 343-8602
Addresses
Street Address
13279 N CLEVELAND AVE
NORTH FORT MYERS, FL 33903-4818
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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April 2025
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