SUPERVALU PHARMACIES INC – Community/Retail Pharmacy, NPI 1184700049
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SUPERVALU PHARMACIES INC
421 3RD ST S
STILLWATER, MN 550824955
Phone: (651) 779-4023
Fax: (651) 779-2023
Type: Location
11840, Valley View Road, Eden Prairie, Hennepin County, Minnesota, 55344, United States
EDEN PRAIRIE, MN 553443643
Phone: (952) 828-4588
Fax: (952) 947-3470
Type: Location
PO BOX 776418
CHICAGO, IL 606776418
Phone: (952) 828-4588
Fax: (952) 947-3470
Type: Mailing
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: 2007-09-19
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-02-29 (837 days ago).
Enrollment records
1
Earliest due date
2024-02-29
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 |
|---|---|---|---|---|
| O20070919000434 | O | Centralized Flu Biller | TX | 2024-02-29 |
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 |
|---|---|---|---|---|
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 36,584 | 4,096 | $0 |
| G0008 | Administration of influenza virus vaccine | 12,603 | 12,568 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 11,445 | 11,417 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 10,458 | 10,447 | $0 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 6,810 | 6,806 | $0 |
Insurance plans in this area (ZIP 55082)
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