Contract Pharmacy Details

OPTUM PHARMACY 702, LLC
FQHCLA335 LEE MEMORIAL HEALTH SYSTEM

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

OPTUM PHARMACY 702, LLC

Pharmacy Address

1050 PATROL RD
JEFFERSONVILLE, IN 47130

Pharmacy Comments

Contract Details

Approval Date

4/18/2023

Contract Begin Date

7/1/2023

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

Optum
Nancy McCutcheon, SR VP of Strategic Sales
(651) 983-0677

Signed By Date

4/18/2023

340B Drug Pricing Program Database