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SAMS EAST INC
NPI 1134514391
Pharmacy - Community/Retail Pharmacy in Jefferson City, MO

Active since April 03, 2015CLIA 26D2126436 · Waiver
849 STONERIDGE PKWY, JEFFERSON CITY, MO 65109(479) 204-8850(479) 277-4331 Get Directions Write a Review

NPPES record last updated: June 6, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 6, 2025, Nov 9, 2015 (2 updates tracked since 2015).

About Sams East Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAMS EAST INC (NPI 1134514391), doing business as Sam's Pharmacy 10-6505, is a healthcare organization registered as a community/retail pharmacy in Jefferson City, Missouri and active in the NPI registry since April 2015. The organization holds a CLIA Waiver certificate valid through February 27, 2027 and lists Kimberly Canonic, Senior Director, Enrollment, as its authorized official.

NPPES Registry Identity

NPI1134514391
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSAMS EAST INC
Location Address849 STONERIDGE PKWYJefferson City, MO 65109-5034
Mailing Address702 Sw 8th StBentonville, AR 72716-6209 · (479) 204-8550 · Fax (479) 277-4331
Phone(479) 204-8850
Fax(479) 277-4331
Organization SubpartNo
Authorized OfficialKimberly CanonicSenior Director, Enrollment · (480) 277-6348
Enumeration DateApril 3, 2015
Last NPPES UpdateJune 6, 20252 updates tracked since enumeration
NPPES CertifiedJune 6, 2025
✔ NPI 1134514391 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in MO · 2015021516
Definition
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
849 STONERIDGE PKWY, Jefferson City, MO 65109
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Other Names 1

Doing Business AsSam's Pharmacy 10-6505

Other Identifiers 2

Medicaid1134514391MO
Other2151852Pk

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D2126436

Sam's East, Inc Dba Sam's Pharmacy 10-6505 · Jefferson City, MO
Active · expires Feb 27, 2027
CLIA Number26D2126436
Laboratory TypePharmacy
Certificate Effective DateFebruary 28, 2025
Certificate Expiration DateFebruary 27, 2027
Laboratory DirectorSamuel Branum
Laboratory Phone(573) 469-0906
Laboratory LocationSam's East, Inc Dba Sam's Pharmacy 10-6505849 Stoneridge Parkway, Jefferson City, MO 65109
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
136 services133 patients
Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
127 services127 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
12 services12 patients

Medical Equipment Supplier Medicare DMEPOS 12

Medicare supplier enrollment and the product categories Sam's Club Pharmacy 10-6505 carries, from the Medicare DMEPOS supplier directory.

Sam's Club Pharmacy 10-6505

DMEPOS supplier · Jefferson City, MOOperated by Sam's East, Inc.
⋮

Does not accept Medicare assignment

Sam's Club Pharmacy 10-6505 has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20514335
Medicare Participant SinceMay 15, 2013
Supplier Location849 Stoneridge PkwyJefferson City, MO 65109
Phone(573) 469-0906
Supplier Specialties
Pharmacy

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MENDY SCHMID HIS
Hearing Instrument Specialist
849 STONERIDGE PKWY
JEFFERSON CITY, MO 65109
Cole County (573) 469-0056
MRS. JENNIFER OHNESORGE
Student in an Organized Health Care Education/Training Program
849 STONERIDGE PKWY
JEFFERSON CITY, MO 65109
Cole County (573) 469-0906
STEFANIE WEBER
Pharmacist
849 STONERIDGE PKWY
JEFFERSON CITY, MO 65109
Cole County (573) 469-0906
SAM'S EAST, INC
Eyewear Supplier
849 STONERIDGE PKWY
JEFFERSON CITY, MO 65109
Cole County (479) 204-8550
CORY MYREN AU.D.
Audiologist
849 STONERIDGE PKWY
JEFFERSON CITY, MO 65109
Cole County (573) 694-2805

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sams East Inc's NPI number?

The NPI number for Sams East Inc is 1134514391. It was assigned to this organization in the NPPES registry on April 3, 2015. The provider is doing business as Sam's Pharmacy 10-6505.

Where is Sams East Inc located?

Sams East Inc is located at 849 Stoneridge Pkwy, Jefferson City, MO 65109. The listed phone number is (479) 204-8850.

What is Sams East Inc's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Sams East Inc accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Sam's Club Pharmacy 10-6505 does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

Does Sams East Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2126436) is associated with this NPI, valid through February 27, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Sams East Inc accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arizona Complete Health and 50 other insurers list Sams East Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sams East Inc was last updated on June 6, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.