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Walgreens #21395
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
Walgreens #21395
Pharmacy Address
Walgreens Central Fill #21395
5710 Young Pine Rd
Orlando, FL 32829
Pharmacy Comments
Contract Details
Approval Date
10/18/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Benjamin Spence, CFO
(239) 343-6014
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President,
(847) 315-2663
Signed By Date
10/18/2022
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