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FQHCLA335AN LEE MEMORIAL HEALTH SYSTEM (Terminated)
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Main Details
Name
LEE MEMORIAL HEALTH SYSTEM
Subdivision Name
Internal Medicine Office Matthew Drive
Type
Health Center Program Look-Alike
Site ID
BPS-LAL-036959
340B ID
FQHCLA335AN
Grant Number
LALCS00171
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2023
Participating Start Date
1/1/2024
Participating Approval Date
10/16/2023
Last Recertification Date
2/1/2024
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
1569 Matthew Dr
Fort Myers, FL 33907-1701
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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