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LEE MEMORIAL HEALTH SYSTEM
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
LEE MEMORIAL HEALTH SYSTEM
Pharmacy Address
LEE PHARMACY 7
23450 VIA COCONUT PT
ESTERO, FL 34135-1877
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
5/14/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Agreement registered in error
Contacts
Covered Entity Signing Official
Benjamin Spence, CFO
(239) 343-6014
Contract Pharmacy Representative
Lee Health
John Armitstead, System Director Pharmacy
(239) 343-6490
Signed By Date
4/15/2020
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