Washington
Statewide
Department Of Health
Last updated: 5/15/2024
Pharmacy Ancillary Utilization Application
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Description
PHARMACY ANCILLARY UTILIZATION APPLICATION. This form is used by the Washington State Department of Health, by the Pharmacy Quality Assurance Commission. It is for pharmacies to apply for or update their ancillary utilization plans, which must be submitted at least 60 days prior to the next Pharmacy Commission business meeting. The form collects demographic information about the pharmacy, including its license number, address, and key individuals involved. It requires certification by the owner/authorized representative of the pharmacy and the responsible pharmacist, stating their compliance with state laws and regulations. www.FormsWorkflow.com
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