Wisconsin Department of Safety and Professional Services
Health & Business Renewal Application
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
:
12/08/2017
Application#
:
628029
Name
:
WALGREENS
Profession
:
Pharmacy (out of state)
Address
:
Deerfield, IL
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
11/27/17: Field left blank on submitted application. Please provide this information. Per Form 2737 instructions "(Required for a Change-in-Ownership or a
Change–in-Location.)" You may send this information via e-mail to: DSPSCredPharmacy@wi.gov. Please refer to your application ID number in your correspondence. Thank you. /tg;
Proposed Closing date
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
11/27/17: IMPORTANT- PLEASE READ. The Wisconsin enhanced Prescription Drug Monitoring Program (WI ePDMP) is a new tool to help combat the ongoing prescription drug abuse epidemic in Wisconsin. It is now available at: https://pdmp.wi.gov . Please review website for any requirements that would be applicable to your pharmacy once a credential has been issued. Please contact ePDMP staff at PDMP@wisconsin.gov or 608.266.0011 if you have questions. /tg;
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