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FQHCLA335L Lee Memorial Health System (Terminated)
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Main Details
Name
Lee Memorial Health System
Subdivision Name
Golisano Pediatrics Port Charlotte Harbor Blvd.
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-030598
340B ID
FQHCLA335L
Grant Number
LALCS00171
Additional Details
Current Program Status
Terminated
Registration Date
7/28/2020
Participating Start Date
10/1/2020
Participating Approval Date
7/29/2020
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
2525 Harbor Blvd Ste 204
Port Charlotte, FL 33952-5342
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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