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  :  02/08/2022
Application#  :  765025
Name  :  353 Empire Pharmacy Inc
Profession  :  Pharmacy (out of state)
Address  :  Brooklyn, NY
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
5/20/2021: Your application has been reviewed. This item will remain unmet until all other requirements are met. – FG

5/18/21: Your application has been received & entered. Your application has not been reviewed. (Requirements will remain “Not Met” until your application has been reviewed.) Initial application review may take at least 3 weeks from the date your application was entered into the system. Thank you. JA
Application Fee Met
5/20/2021: Payment was not received with application. Mail to Attn: Pharmacy, DSPS, PO Box 8935, Madison, WI 53708-8935 or send Fax Payment Form #3071 to 608-251-3036. Please include application ID with all correspondence. - FG $70
Applicant address of facility Met
Mailing address until day of opening Met
Proposed Opening date Met
ANY CHANGE IN OPENING DATE WILL NEED TO BE COMMUNICATED TO THE BOARD OF PHARMACY BY WRITTEN CORRESPONDENCE TO OUR MAILING ADDRESS OR BY EMAIL - DSPSCREDPHARMACY@WI.GOV. Please include application ID with all correspondence. - FG
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
FYI-IMPORTANT- PLEASE READ. FYI ONLY -- 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 regarding ePDMP.