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CUB PHARMACY
NPI 1215042353
Pharmacy - Community/Retail Pharmacy in Plymouth, MN

Active since August 20, 2006CLIA 24D1067467 · Waiver
3550 VICKSBURG LN N, PLYMOUTH, MN 55447(763) 553-2627(763) 557-9554 Get Directions Write a Review

NPPES record last updated: October 3, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Cub Pharmacy NPPES

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

CUB PHARMACY (NPI 1215042353) is a healthcare organization registered as a community/retail pharmacy in Plymouth, Minnesota and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through April 18, 2027 and lists Aaron Sapp, Director Of Pharmacy Services, as its authorized official.

NPPES Registry Identity

NPI1215042353
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSUPERVALU PHARMACIES INC
Location Address3550 VICKSBURG LN NPlymouth, MN 55447-1322
Mailing Address11840 Valley View Rd, Attn: Managed Care Pharmacy Dept.Eden Prairie, MN 55344-3643 · (952) 828-4588 · Fax (952) 947-3470
Phone(763) 553-2627
Fax(763) 557-9554
Organization SubpartNo
Authorized OfficialAaron SappDirector Of Pharmacy Services · (952) 828-4026
Enumeration DateAugust 20, 2006
Last NPPES UpdateOctober 3, 2016
✔ NPI 1215042353 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in MN · 260753
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
Also ListedPharmacyTaxonomy 333600000X
3550 VICKSBURG LN N, Plymouth, MN 55447
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Other Names 1

Doing Business AsCub Pharmacy

Other Identifiers 3

Medicaid996860100MN
Other2046807Pk
Medicare NSC0326790010

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 24D1067467

Cub Pharmacy #1650 · Plymouth, MN
Active · expires Apr 18, 2027
CLIA Number24D1067467
Laboratory TypePharmacy
Certificate Effective DateApril 19, 2025
Certificate Expiration DateApril 18, 2027
Laboratory DirectorJoseph Henning
Laboratory Phone(763) 553-2627
Laboratory LocationCub Pharmacy #16503550 Vicksburge Lane North, Plymouth, MN 55447
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS 16

Medicare supplier enrollment and the product categories Cub Pharmacy #1650/624 carries, from the Medicare DMEPOS supplier directory.

Cub Pharmacy #1650/624

DMEPOS supplier · Plymouth, MNOperated by Supervalu Pharmacies Inc
⋮

Does not accept Medicare assignment

Cub Pharmacy #1650/624 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)20569739
Medicare Participant SinceJanuary 1, 2007
Supplier Location3550 Vicksburg Ln NPlymouth, MN 55447
Phone(763) 553-2627
Supplier Specialties
Pharmacy Grocery Store

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 4

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

MONICA MARIE BRANDS RPH
Pharmacist
3550 VICKSBURG LN N
PLYMOUTH, MN 55447
Hennepin County (763) 553-2629
JILL LANDECKER PHARM.D.
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
3550 VICKSBURG LN N
PLYMOUTH, MN 55447
Hennepin County (763) 553-2727
DOUG WHITE RPH
Pharmacist
3550 VICKSBURG LN N
PLYMOUTH, MN 55447
Hennepin County (763) 553-2627
JOSEPH HENNING PHARMD.
Pharmacist
3550 VICKSBURG LN N
PLYMOUTH, MN 55447
Hennepin County (763) 553-2627

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 Supervalu Pharmacies Inc's NPI number?

The NPI number for Supervalu Pharmacies Inc is 1215042353. It was assigned to this organization in the NPPES registry on August 20, 2006. The provider is doing business as Cub Pharmacy.

Where is Supervalu Pharmacies Inc located?

Supervalu Pharmacies Inc is located at 3550 Vicksburg Ln N, Plymouth, MN 55447. The listed phone number is (763) 553-2627.

What is Supervalu Pharmacies Inc's specialty?

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

Does Supervalu Pharmacies Inc accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Cub Pharmacy #1650/624 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 Supervalu Pharmacies Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D1067467) is associated with this NPI, valid through April 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Supervalu Pharmacies 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 48 other insurers list Supervalu Pharmacies 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 Supervalu Pharmacies Inc was last updated on October 3, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years 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.