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CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
FQHCLA335 LEE MEMORIAL HEALTH SYSTEM
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Covered Entity Details
Entity Name
LEE MEMORIAL HEALTH SYSTEM
Subdivision Name
North Fort Myers Medical Office
Type
Health Center Program Look-Alike
340B ID
FQHCLA335
Entity Address
13279 N CLEVELAND AVE
NORTH FORT MYERS, FL 33903-4818
Grant Number
LALCS00171
Participating Start Date
7/1/2015
Last Recertification Date
1/29/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC
Pharmacy Address
DBA CVS/CAREMARK 48067
1780 WALL ST
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
1/18/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Robert Johns, Executive Director for Lee Community Healthcare
(239) 834-9998
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/18/2022
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