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WAL-MART PHARMACY 10-5451
DSH100012 LEE HEALTH SYSTEM, INC. DBA LEE HEALTH
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Covered Entity Details
Entity Name
LEE HEALTH SYSTEM, INC. DBA LEE HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH100012
Entity Address
2776 CLEVELAND AVENUE
FORT MYERS, FL 33901
Medicare Provider Number
100012
Participating Start Date
1/1/2009
Last Recertification Date
8/18/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-5451
Pharmacy Address
3920 SKYLINE BLVD.
CAPE CORAL (S), FL 33914
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/15/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Benjamin Spence, CFO
(239) 343-6014
Contract Pharmacy Representative
Walmart
Julie Howard, Senior Manager, 340B Program
(479) 277-1498
Signed By Date
10/15/2018
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