Application Status Query

Instructions: 

Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.

Please verify the checklist information below, including your address. If your address has changed, please e-mail your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.

As of  :  10/04/2010
Application#  :  379017
Name  :  LAKEVIEW MEDICAL CENTER
Profession  :  Pharmacy (in state)
Address  :  RICE LAKE, WI
Application Status  :  (Permanent license issued)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)
Type of License Met
Application Fee Met
$75
Applicant address of facility Met
Mailing address until day of opening Met
Proposed Opening date Met
01-11-11
Proposed Closing date Met
01-18-11
Owner Partners Corporate Officers, titles, etc Met
Pharmacy Hours Daily Saturday Sunday Met
Barrier Requested? Met
Managing Pharmacist Affidavit and License # Met
Inspection Ready Date (self inspection will be used) Met
01-18-11
Affidavit of applicant, signed. Met
Floor plan - original (scaled to size, location of sink and refrigerator with prescription counter space clearly indicated) Met
Closing Affidavit form #606 Met
will need within 10 days of closure for license # 6248
Federal Identification Number Collection Met
Please provide
Self Inspection Report Met
Submit Request to DEA (for your info only) Met