Contract Pharmacy Details

LEE MEMORIAL HEALTH SYSTEM
FQHCLA335A LEE MEMORIAL HEALTH SYSTEM

Covered Entity Details

Entity Name

LEE MEMORIAL HEALTH SYSTEM

Subdivision Name

P.L. Dunbar Medical Office

Type

Health Center Program Look-Alike

340B ID

FQHCLA335A

Entity Address

3511 Dr. Martin Luther King, Jr. Boulevard
Fort Myers, FL 33916-4651

Grant Number

LALCS00171

Participating Start Date

7/1/2015

Last Recertification Date

1/31/2022

Entity Termination Date

4/1/2023

Pharmacy Details

Pharmacy Name

LEE MEMORIAL HEALTH SYSTEM

Pharmacy Address

GOLISANO CHILDREN'S HOSPITAL OF SOUTHWES
9981 S HEALTHPARK DR
CHILDRENS HOSPITAL OF SOUTHWEST FLORIDA
FORT MYERS, FL 33908-3618

Pharmacy Comments

Contract Details

Approval Date

10/16/2017

Contract Begin Date

1/1/2018

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/10/2019
Agreement registered in error

Contacts

Covered Entity Signing Official

Robert Johns, Executive Director for Lee Community Healthcare
(239) 834-9998

Contract Pharmacy Representative

Lee Memorial Health System
Anson Phetteplace, Pharmacy Supervisor for Lee Memorial Health System
(239) 343-2821

Signed By Date

10/16/2017

340B Drug Pricing Program Database