Third Party Logistics Provider - Change in Designated Representative

An applicant must satisfy all of the following requirements:

• Submit all required information relating to a designated representative.

If operations are conducted at more than one facility, a person acting as a 3rd-party logistics provider or out-of-state 3rd-party logistics provider may apply to obtain a license from the board for each facility.

• Create or log into your LicensE account.

• Complete each of the following forms:

  • Form 7161 - Third Party Logistics Provider Designated Representative Form

  • Form 2687 - Authorization for Release of FBI Information

• Submit the completed forms with any additional documentation to dspscredpharmacy@wisconsin.gov. List 3PL or Third-Party Logistics as the subject line of the email.

• After emailing the forms, log into your LicensE account and click "Request Support". Include 3PL Change in Designated Rep. in the subject line.

• After the credentialing team receives a completed Form 2687, they will email fingerprinting instructions. After completing the fingerprinting, log into your LicensE account and submit a support ticket with the Subject "3PL-Fingerprinting Completed". Include the name of the individual, the TCN number and the date the fingerprints were completed.

• The credentialing team will review the applications and documents and reach out via email. If you have additional questions, please log into your LicensE account and submit a support ticket.

Support Ticket
Submit a support ticket on LicensE and click "request support." Please provide as much detail as possible regarding your concern so we can work to answer your question with a one touch resolution. 

Call
608-266-2112

Email
dsps@wisconsin.gov

Office Hours
7:45am-4:30pm
Department of Safety and Professional Services
4822 Madison Yards Way
Madison, WI, 53705

Note: The in-person office does not process same day.