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  :  04/12/2016
Application#  :  567137
Name  :  ENCOMPASS RX LLC
Profession  :  Pharmacy (out of state)
Address  :  ATLANTA, GA
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
Owner Partners Corporate Officers, titles, etc Met
Pharmacy Hours (daily) Met
Managing Pharmacist listed and other state license number. Met
Copy of current state license or verification letter from state board where current license is held. Met
Wisconsin Patient Contact telephone number Met
Managing Pharmacist/Owners Certification completed and signed. Met
Federal Identification Number Collection Met
4/12/2016: RECEIVED-------
3/31/2016: FEIN number was not included in the submitted application. At this time, please go to our website to obtain a copy of the application (Form #2737) – http://dsps.wi.gov. (Go to Licenses/Permits/Registrations > Health Professions > Pharmacy (Out of State) > Application Forms > Form #2737). On page 1, please complete the FEIN section, DBA name, and write your Application ID number on the form to e-mail back to us at: DSPSCredPharmacy@wi.gov. Thank you.