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MEDPILOT PHARMACY INCORPORATED
CHC26623-02 OPERATION SAMAHAN
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Covered Entity Details
Entity Name
OPERATION SAMAHAN
Subdivision Name
OPSAM HEALTH: 10737 Camino Ruiz Ste. 235
Type
HRSA-Funded Health Center
340B ID
CHC26623-02
Entity Address
10737 Camino Ruiz STE 235
San Diego, CA 92126-2375
Grant Number
H80CS26623
Participating Start Date
4/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MEDPILOT PHARMACY INCORPORATED
Pharmacy Address
9323 CHESAPEAKE DR STE C1
SAN DIEGO, CA 92123-1034
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
archie p bella, executive director
(844) 200-2426 Ext: 1063
Contract Pharmacy Representative
MedPilot Pharmacy
Jacky Lee, Owner
(858) 278-7500
Signed By Date
10/14/2022
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