CLIA lab
CLIA 24D2099825: Sam's Pharmacy 10-6254
Maple Grove, MN. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 24D2099825 belongs to Sam's Pharmacy 10-6254 in Maple Grove, MN.
Certificate of Waiver, effective August 3, 2025, expires August 2, 2027.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- August 3, 2025
- Certificate expiration
- August 2, 2027
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- August 3, 2015
- Facility type
- Pharmacy
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 24D2099825
- Lab name
- Sam's Pharmacy 10-6254
- Address
- 16701 94th Ave North, Maple Grove, MN 55311
- Phone
- (763) 416-5930
- Fax
- (763) 416-5932
Annual test volume the lab reported
- Waived tests
- 5,000
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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Related
Questions
What is the CLIA number for Sam's Pharmacy 10-6254 in Maple Grove?
24D2099825, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does Sam's Pharmacy 10-6254 hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 24D2099825 expire?
The CMS file lists August 2, 2027 as the certificate expiration date; the certificate took effect August 3, 2025.