SAM'S PHARMACY 10-4787
NPI 1356368757
Pharmacy - Community/Retail Pharmacy in Bloomington, MN

Q: What is Sams West Inc's NPI number?

The NPI number for Sams West Inc is 1356368757. It was assigned to this organization in the NPPES registry on July 16, 2006. The provider is doing business as Sam's Pharmacy 10-4787.

Q: What is Sams West Inc's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Sams West Inc was last updated on August 29, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 16, 2006CLIA 24D2099827 · Waiver

200 AMERICAN BLVD W, BLOOMINGTON, MN 55420(952) 888-6079(952) 888-6095 Get Directions Write a Review

NPPES record last updated: August 29, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 29, 2023, Oct 31, 2018, May 10, 2016 and 1 more (4 updates tracked since 2015).

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About Sam's Pharmacy 10-4787 NPPES

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

SAM'S PHARMACY 10-4787 (NPI 1356368757) is a healthcare organization registered as a community/retail pharmacy in Bloomington, Minnesota and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through August 2, 2027 and lists Cory Jon Gundberg, Svp, as its authorized official.

NPPES Registry Identity

NPI1356368757

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameSAMS WEST INC

Location Address200 AMERICAN BLVD WBloomington, MN 55420-1120

Mailing Address702 Sw 8th StBentonville, AR 72716-0445 · (479) 258-6724 · Fax (479) 277-4331

Phone(952) 888-6079

Fax(952) 888-6095

Organization SubpartNo

Authorized OfficialCory Jon GundbergSvp · (479) 277-2500

Enumeration DateJuly 16, 2006

Last NPPES UpdateAugust 29, 20234 updates tracked since enumeration

NPPES CertifiedAugust 29, 2023

✔ NPI 1356368757 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 · 262274

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

200 AMERICAN BLVD W, Bloomington, MN 55420

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Other Names 1

Doing Business AsSam's Pharmacy 10-4787

Other Identifiers 2

Medicaid470053800MN

Other2048384Pk

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 24D2099827

Sam's Pharmacy 10-4787 · Bloomington, MN

Active · expires Aug 2, 2027

CLIA Number24D2099827

Laboratory TypePharmacy

Certificate Effective DateAugust 3, 2025

Certificate Expiration DateAugust 2, 2027

Laboratory DirectorAmanda Timmerman

Laboratory Phone(952) 888-6079

Laboratory LocationSam's Pharmacy 10-4787200 American Blvd West, Bloomington, MN 55420

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 4

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.

143 services142 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.

133 services133 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677

The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.

11 services11 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.

11 services11 patients

Medical Equipment Supplier Medicare DMEPOS 12

Medicare supplier enrollment and the product categories Sams Pharmacy 10-4787 carries, from the Medicare DMEPOS supplier directory.

Sams Pharmacy 10-4787

DMEPOS supplier · Minneapolis, MNOperated by Sams West Inc

✔

Accepts Medicare assignment

Sams Pharmacy 10-4787 agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20452727

Medicare Participant SinceNovember 1, 2018

Supplier Location200 American Blvd WMinneapolis, MN 55420

Phone(952) 888-6079

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.

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Other Providers at the Same Location NPPES 8

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

SAM'S CLUB OPTICAL

Eyewear Supplier