SAMS PHARMACY 10-6204 – Community/Retail Pharmacy, NPI 1629095963
Community/Retail Pharmacy
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Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for SAMS PHARMACY 10-6204
Walmart Home Office Main Entrance, 702, Southwest 8th Street, Bentonville, Benton County, Arkansas, 72712, United States
BENTONVILLE, AR 727160445
Phone:
Type: Mailing
Sam's Club, 450, Norman Drive, Valdosta, Lowndes County, Georgia, 31601, United States
VALDOSTA, GA 316017708
Phone: (229) 244-7677
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-09-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-08-31 (648 days ago).
Enrollment records
1
Earliest due date
2024-08-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20100930022949 | O | Pharmacy | GA | 2024-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0008 | Administration of influenza virus vaccine | 119 | 119 | $0 |
| 90694 | Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage | 114 | 114 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 66 | 66 | $0 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 40 | 40 | $0 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 26 | 26 | $0 |
Insurance plans in this area (ZIP 72716)
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