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3PL License

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Third-Party Logistics Providers (3PL)

A Third-Party Logistics Provider is defined as an entity that provides or coordinates warehousing or other logistics services of a product in interstate commerce on behalf of a manufacturer, wholesale distributor, or dispenser of a product, but does not take ownership of the product nor have responsibility to direct the sale or other disposition of the product.

3PL license. Beginning April 1, 2019, every 3PL as defined in rule 657—43.2(87GA,SF2298), wherever located, that provides or coordinates warehousing or other logistics services of products into, out of, or within this state must be licensed by the Board in accordance with the laws and rules of Iowa before engaging in such logistics operations. Where activities are conducted at more than one location by a single 3PL, each location shall be separately licensed. The applicant shall submit a completed application with a nonrefundable application fee of $750. A 3PL that handles controlled substances shall also obtain a controlled substances Act registration pursuant to 657—Chapter 10.

Iowa Regulations

657 Iowa Administrative Code Chapter 43 governs the practice of 3PLs that operate in or into the state of Iowa.

Have you reviewed and do you understand the Iowa regulations pertaining to 3PLs?

Yes

Required Documents

Is the 3PL physically located in the state of Iowa?

Yes

Additional Documents

The following documents may be required to be uploaded with your application:

1.Home State License Verification

2.DEA Certificate

3.Proof of Accreditations

4.FDA 483s, Warning Letters, and Responses

5.FDA Inspection Report

6.Documentation of the conviction(s) for any criminal history not previously provided to the Board.

7.Documentation of the final disciplinary order(s) for any disciplinary history not previously provided to the Board

8.Documentation of the final denial order(s) by a licensing authority not previously provided to the Board.

Facility

Has your facility ever been licensed with the Iowa Board of Pharmacy, in any capacity, at the facility’s current physical location?

Yes

Business Name

Street Address

C S Z

License Number

Business Information

Business name (dba)

Legal Name

FEIN

NABP E-Profile

If you do not have an NABP e-profile number, you may create one by clicking here

Type of Ownership

State of Incorporation or Governance

Date Established

Physical Address

Address Line 1

Address Line 2

Address Line 3

Country

Zip

City

State

County

Home State License Verification (only if located outside the state of Iowa)

Mailing Address

Check if mailing address is the same as physical address.

Address Line 1

Address Line 2

Address Line 3

Country

Zip

City

State

County

3PL Contact Information

Note : The facility phone number must be a direct number to the proposed licensed facility

Phone Type

Facility Phone #

Will you accept text messages?

Yes

Phone Type

Alternate Phone # for Facility

Will you accept text messages?

Yes

E-mail

Fax #

Website

Ownership Information

Name of Legal Owner

Address of Legal Owner

Zip

City

State

Phone #

Fax #

E-mail

Hours of Operation

* (Open and Close times for each day must be completed or “Closed” check box must be marked)

If facility is not open on any day, check the “Closed” box. If facility is open any day, record the times the facility opens and closes by entering the hour:minute and indicating ‘am’ or ‘pm’.

1.Sunday

Open

Closed

2.Monday

Open

Closed

3.Tuesday

Open

Closed

4.Wednesday

Open

Closed

5.Thursday

Open

Closed

6.Friday

Open

Closed

7.Saturday

Open

Closed

Registered Agent

In the event that legal documents or correspondences must be served, they will be served to your Registered Agent. Your Registered Agent must be physically located in Iowa.

Name

Address1

Address2

Address3

Zip Code

City

State

Phone number

Fax number

Controlled Substances

Do you distribute, dispense, manufacture, or prepare for administration any controlled substances in or into Iowa?

Yes

Controlled Substance Act Registration Required

You are required to apply for and maintain a Controlled Substances Act-Business Registration for each activity involving the handling of controlled substances in or into Iowa. The fee for each type of registration is $90 and is renewed biennially.

Please check this box if you are not currently registered by the Iowa Board of Pharmacy to handle controlled substances in or into Iowa

Note : Do not check the box if you hold a current CSA-Business registration as a distributor.

Controlled Substances Handled

Select the schedules of controlled substances you intend to distribute in or into Iowa

Federal Drug Enforcement Administration (DEA)

Federal DEA Registration#

Federal DEA Registration Expiration Date

DEA Certificate

Inspection

Have you ever been inspected by a state licensing authority or other third-party?

Yes

Food and Drug Administration (FDA)

Is your facility registered with the FDA?

Yes

Food and Drug Administration (FDA)

Has your facility been inspected by the FDA?

Yes

Food and Drug Administration (FDA)

Has your facility ever been issued an FDA Warning Letter?

Yes

Accreditations

Note : Your facility must be VAWD-accredited to qualify for licensure as a 3PL in Iowa. Please contact the National Association of Boards of Pharmacy (NABP) at [email protected] to obtain VAWD accreditation.

Waiver Order/Approval Letter

Other State Licenses

Do you hold licenses in any other states?

Yes

Other State Licenses

Please identify all other state licenses:

State

Licensing Body

License number

License Status

License issue date

License Expiration Date

Other State License

Facility Manager

Provide full legal name

First name

Middle name

Last name

Other names used

Address1

Address2

Address3

Zip

City

State

Social Security #

Date of Birth

Phone Type

Phone Number

Accept Text Message

Yes

Alternate Phone Type

Alternate Phone Number

E-mail

Accept Text Message

Yes

Government Issued Identification

Facility Manager Attestation

As Facility Manager, I, First Name Last Name, attest that I have adequate experience in prescription drug and device distribution and am actively involved in the daily operation of the third party logistics provider. I have and will maintain a functional understanding of federal and state laws, rules, and regulations pertaining to drug and device distribution.

I hereby swear or affirm that I, First Name Last Name, have no felony convictions or convictions related to prescription drug and device distribution, including distribution of controlled substances.

Signature

Facility Manager Resume

Criminal History

Has the 3PL, any owner, or Facility Manager been convicted of or entered a plea of guilty, nolo contendere, or no contest to any crime related to prescription drugs, controlled substances, healthcare, or the practice of pharmacy in any jurisdiction? You must include all misdemeanors and felonies, even if adjudication was withheld by the court so that you would not have a record of conviction.

Yes

All convictions, except for minor traffic offenses, must be disclosed. Conviction means a finding, plea, or verdict of guilt made or returned in a criminal proceeding, even if the adjudication of guilt is deferred, withheld, or not entered. Conviction includes Alford pleas and pleas of nolo contendere. You must submit the complaint and judgment of conviction for each offense and a personal statement regarding whether each conviction directly relates to the practice of the profession. Your application will not be considered complete until the entirety of this information is received by the Board.

Disciplinary Actions

Has the 3PL, any owner, or Facility Manager been disciplined by any licensing authority? Discipline includes, but is not limited to, citations, reprimands, fines, and license/registration restrictions, probation, suspension, revocation or surrender.

IBOP Discipline

Yes

Discipline – Not Iowa / Outside Iowa

Yes

License Denials

Has the 3PL ever been denied a license or registration by any licensing authority?

Yes

Pending Investigations

Do you have any knowledge of any investigations, complaints, or charges pending before any licensing authority?

Yes

Preview

Confirm and Submit

I hereby swear or affirm under the penalty of perjury that the information provided in this application is true and correct. I understand that failure to provide complete and truthful information may constitute grounds for denial, revocation, or other disciplinary sanctions against my license.

Signature

Title

Date

Please note that after you click the Submit button, you cannot make changes to your application.

License/Registration Type

State Licensing Body

License/Registration number

License/Registration Status

License/Registration issue date

License/Registration expire date

Proof of Accreditations

Physical and Mailing Address: 6200 Park Avenue, Suite 100, Des Moines, IA 50321-1270. (P): (515) 281-5944 (F): (515) 281-4609

Human Prescription Drugs	Human Controlled Substances	Human Nonprescription Drugs
Veterinary-Companion Animal Prescription Drugs	Veterinary-Companion Animal Nonprescription Drugs	Veterinary-Companion Animal Controlled Substances
Veterinary-Food Producing Animal Prescription Drugs	Veterinary-Food Producing Animal Nonprescription Drugs	Veterinary-Food Producing Animal Controlled Substances
Active Pharmaceutical Ingredients (API)	Patient Use Prescription Medical Devices	Professional Use Prescription Medical Devices
Non-prescription Medical Devices	Prescription Combination Products Medical Convenience Kits IV Fluids/electrolyte Radioactive drugs Irrigation/sterile Water Solution	Dialysis Solution
Blood and/or Blood Products	Medical Gases	Other

VAWD	Board-Approved Waiver of VAWD	DMEPOS	CHAP	ACHC
Joint Commissions	Other
None