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DSH100012AF LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
LEE MEMORIAL HEALTH SYSTEM DBA LEE MEMORIAL HOSPITAL
Subdivision Name
THE OUTPATIENT CENTER AT HEALTHPARK COMMONS - Asthma/COPD Management
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100012AF
Medicare Provider Number
100012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2019
Participating Start Date
10/1/2019
Participating Approval Date
9/3/2019
Last Recertification Date
8/21/2023
Termination Date
Termination Reason
7/1/2024
Business decision by the Covered Entity
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
16281 Bass Road
Suite 305 (Asthma/COPD Management)
Fort Myers, FL 33908
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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