Pharmacy (In-State)


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License Information

Per Wis. Stat. § 440.08 (2), the required renewal date for the Pharmacy (In-State) credential is 05/31/even years.  Should you receive your initial credential in the months leading up to this date, you are still required to renew your license by the statutorily defined date.

The completed application with the fee and required documentation must be submitted at least 30 days prior to date the applicant wishes to open the pharmacy. Make sure to provide all requested information.

  • ​The location of the pharmacy​

  • ​A floor plan of the pharmacy. Enclose one set of original floor plans, scaled to size, with a description of the various areas designated. Indicate location of sink and refrigerator. For specific floor plan requirements refer to Wis. Admin. Code ch.​ Phar 6​

  • The name of the managing pharmacist. Every pharmacy shall be under the control of the managing pharmacist who is listed on Department records. The managing pharmacist shall be responsible for the professional operations of the pharmacy. A pharmacist may be the managing pharmacist of not more than one community and one institutional pharmacy at any time and shall be engaged in the practice of pharmacy at each location he or she supervises. Use Form 2516​ to report changes in the managing pharmacist. 

  • Self-Inspection Report (Form 2550)​. This ​form must​ be completed and returned to the Department prior to opening.

To license a pharmacy where a change of ownership or change of location is involved, complete the steps above plus submit a Pharmacy Closing Affidavit (Form 606​) completed and notarized by the former owner and forward it to the board office with the other required materials.

Register with the Drug Enforcement Administration (DEA).


Application for Pharmacy (In State) Packet

FormDescription
609Information for In-State Pharmacy License Application
1301Instructions to Applicants for Pharmacy Change of Ownership/Location Change /Original Licensure (This form is available to determine if licensure is required.)
​3217​Application for Fee Reduction (This form must accompany the application for the credential.)
​606​Pharmacy Closing Affidavit (This form is required to close a pharmacy and must be submitted within ten days of closure.)
1422​Pharmacy Self-Inspection Information Sheet
2550​Pharmacy Self-Inspection Report
​3085​Application for Predetermination (OPTIONAL-Submit ONLY if you have been convicted of any felony, misdemeanor, or other violations of federal or state law in this state or any other and you desire a review of your conviction record before applying for a credential.)​
2252​Convictions and Pending Charges (if applicable)
3071​Fax Payment Form

Profession Forms

FormDescription
2556Business Models and Requirements for Licensure (information regarding Out-of-State Pharmacy, Distributor, Manufacturer)
2516Change Managing Pharmacist Form (This form is required anytime a change in Managing Pharmacist occurs.)
2661Change of Name, Ownership, Location or Address for Pharmacy, Wholesale Distributor or Manufacturer (Instructions and Information)
​2866​Pharmacy Remodel Request Form
2634​Pharmacy Remodel Request Information Sheet (Instructions for filing Remodel Request Form #2866)
2874Remote Dispensing Site Notice (Completed form must be submitted to the Board prior to operating remote site.)

Procedures for Reporting DEA Theft or Loss of Controlled Substances

FormDescription
2691Division of Enforcement Supplemental DEA Form for Reporting of Theft or Loss of Controlled Substances
2821Procedures for Reporting Theft or Loss of Controlled Substances (You will also need to contact the DEA and complete the DEA Form for Reporting a Theft or Loss of Controlled Substances.)

Variance Forms

FormDescription
2867Pharmacy Variance Request Form and Information

Pilot Program Forms

FormDescription
Please click here for all Pilot Program Forms

Renewal Information

Requirements

  • FEE (See Renewal Dates and Fees)
  • SIG (Signature regarding the current Pharmacist in Charge and the Pharmacy Fax #. Pharmacist in Charge must have an active WI pharmacist license and be in charge of no more than 1 community pharmacy and 1 institutional pharmacy at a time.)

Important Notice: Please check the DSPS Pharmacy Examining Board rules and statutes site for the latest changes.

Renewal Methods

FormDescription
RDAFRenewal Dates and Fees