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OPTUM PHARMACY 701, LLC
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
OPTUM PHARMACY 701, LLC
Pharmacy Address
4100 S SAGINAW ST STE D
FLINT, MI 48507
Pharmacy Comments
Contract Details
Approval Date
4/11/2022
Contract Begin Date
4/13/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/20/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Benjamin Spence, CFO
(239) 343-6014
Contract Pharmacy Representative
Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677
Signed By Date
4/11/2022
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