:: Initial Applications ::

Pharmacist License by License Transfer

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Waiver of Fee -- Determination of Eligibility

An applicant for an initial license or registration is eligible for a waiver of the initial fee(s) if the applicant’s adjusted gross household income does not exceed 200% of the Federal Poverty Level and the applicant is applying for this specific license/registration category for the first time.

To determine eligibility, you must first identify the number of individuals in your household. Once this is determined, reference the Federal Poverty Level and identify your adjusted gross income that matches the number of individuals in your household. If your adjusted gross household income, as reported on your most recent federal tax return, is less than the identified value, you are eligible for the one-time fee waiver.

If you determine that you are eligible for the one-time fee waiver, you will be provided an opportunity to request the waiver at the end of this application. You will also be required to upload a copy of your household Federal Tax Return for the preceding year.

If you are married and filed separately, you will need to submit the Federal Tax Return for both your spouse and yourself.
If you were claimed as a dependent on another person’s tax return, you will need to submit the Federal Tax Return for the tax filer who claimed you as a dependent.

Please be sure you have the required documents ready before proceeding with this application. If your documents are not available for upload when the waiver opportunity is presented, you will need to redo this entire application to request a fee waiver.

Initial Pharmacist License by License Transfer

You are applying for a license to practice pharmacy in Iowa by License Transfer (Pharmacist License). Licensure is required prior to practicing pharmacy in Iowa. (This process was formerly known as Reciprocity.)

During the process of completing this application, you will be offered the opportunity to apply for a Temporary Pharmacist License by License Transfer. With a temporary license, you will be permitted to practice pharmacy in Iowa for a limited period while preparing for and successfully completing the Multi-State Pharmacy Jurisprudence Examination (MPJE)-Iowa Edition. Prior to being granted a temporary license, a criminal history background check must be completed by this Board. Requirements and procedures relating to the criminal history background check are addressed later in this application.

The fee for a Pharmacist License by License Transfer (without temporary licensure) is $315 and includes:

$270 Application fee (administration fee and biennial license fee)

$45 Criminal Background Check fee

Initial Pharmacist License by License Transfer – Temporary License Option

You may apply for a Temporary License to practice pharmacy in Iowa by License Transfer. Licensure is required prior to practicing pharmacy in Iowa. Temporary Licensure by License Transfer requires completion of this application with total payment to the Iowa Board of Pharmacy in the amount of $335. This fee includes:

$315 fee for Pharmacist License by License Transfer ($270 Application Fee plus $45 Criminal Background Check Fee).

$20 additional application fee (temporary license issued for 3 months, pending completion of MPJE-Iowa Edition). The criminal history background check is required prior to issuance of a temporary license.

If, at the end of the 3-month temporary license period you have not taken and passed the MPJE-Iowa Edition, you may apply to renew the Temporary Pharmacist License by License Transfer by completing and submitting the renewal application and paying the required $20 renewal fee for an additional 3 months.

Would you like to apply for and obtain a Temporary License by License Transfer while you study to take and pass the MPJE-Iowa Edition exam?

Yes

Disclosure of Medical Conditions, Criminal History, and Disciplinary Action

Be advised that the application for Pharmacist License by License Transfer asks about any medical conditions you have that might impair your ability to perform the duties of a pharmacist. The Board also considers any prior criminal history and disciplinary actions when issuing licenses or registrations. As part of the application process you will be asked questions about these issues.

If you have any questions concerning these requirements, please notify the Board office. If any of these situations pertain to you, there may be delays at the time of processing your application. We suggest you contact the Board office for information as to what documentation may be necessary for licensure. Contacting the Board office about any of these situations may avoid unnecessary delays at the time of licensure.

Definitions

Important! Read these definitions before completing this application.

“Ability to perform required pharmacist-related tasks with reasonable skill and safety” means ALL of the following:

The cognitive capacity to use pharmacy systems to obtain necessary patient and prescription related information to process prescriptions

The ability to effectively communicate information to other pharmacists, interns, providers, technicians, pharmacy support persons, and patients

The ability to perform required tasks such as filling prescriptions, counseling patients, performing drug utilization reviews, and other professional pharmacy services

“Medical condition” means any physiological, mental, or psychological condition, impairment, or disorder, including drug addiction and alcoholism.

“Chemical substances” means alcohol, legal and illegal drugs, or medications, including those taken pursuant to a valid prescription for legitimate medical purposes and in accordance with the prescriber’s direction, as well as those used illegally.

“Improper use of drugs or other chemical substances” means ANY of the following:

The use of any controlled drug, legend drug, or other chemical substances for any purpose other than as directed by a licensed health care practitioner; and

The use of any substance, including but not limited to, petroleum products, adhesive products, nitrous oxide, and other chemical substances for mood enhancement.

“Illegal use of drugs or other chemical substances” means the manufacture, possession, distribution, or use of any drug or chemical substance prohibited by law.

“Currently”does not mean on the day of, or even in weeks or months preceding the completion of this application. Rather, it means recently enough so that the use of chemical substances or medical conditions may have an ongoing impact on the ability to function and perform the duties required of a pharmacist, or has adversely affected the ability to function and perform the duties required of a pharmacist within the past two (2) years.

Initial Pharmacist License by License Transfer

When completing this application, please be advised of the following:

All sections of the application must be completed.

All required document uploads must be included.

Failure to answer all questions completely or accurately, and/or omission or falsification of material facts, may be cause for denial of your application or disciplinary action. If you are in doubt, answer “yes” and provide an explanation.

All application fees are nonrefundable and may not be transferred for other purposes.

A completed criminal history background check is required before a temporary or permanent license to practice pharmacy in Iowa will be granted.

Required Documents

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

1. Documentation of the final disciplinary order(s) taken against any license or registration held by you in any jurisdiction.

2. Documentation of any final denial order(s) by a licensing authority.

3. Documentation of any criminal convictions and court records, excluding minor traffic violations.

4. Copy of a government-issued photo identification such as driver’s license or passport.

Initial Pharmacist License by License Transfer

Eligibility, Exam, and Application Requirements and Information

1. You must have completed the electronic License Transfer Application on NABP’s website www.nabp.pharmacy, including online payment by credit card of NABP’s application fee.

2. You must complete the Iowa Board of Pharmacy (Board) application for initial Pharmacist License by License Transfer (this application), including payment of required fees totaling $315 ($335 if requesting a temporary license).

3. The NAPLEX/MPJE Registration Bulletin is available on NABP’s website. The MPJE includes questions on federal and state pharmacy and drug laws. Board rules (657 Iowa Administrative Code) and applicable Iowa Code chapters can be found on the Board’s website at https://pharmacy.iowa.gov/ruleslaws.

4. You must take and pass the MPJE-Iowa Edition within one year of the date the NABP Official Application for Transfer of Pharmacist Licensure is issued by NABP. Apply online for the MPJE-Iowa Edition on NABP’s website. The MPJE registration and examination process is a multi-step process:

Apply to take the exam by logging into your NABP e-Profile, choose the jurisdiction (i.e. Iowa) or jurisdictions for which you are seeking eligibility, and submit a $100 fee for each selected jurisdiction. Once eligibility has been granted, you will receive an email prompting you to proceed to the next step and purchase the exam.

Once eligibility has been granted, log into your NABP e-Profile to pay the applicable MPJE fee ($150 per jurisdiction). Once you have purchased your exam you will receive your Authorization to Test (ATT) which allows you to schedule your exam.

Contact an authorized testing site to schedule your MPJE-Iowa Edition.

If you opt for a Temporary Pharmacist License by License Transfer, the following apply:

1. The criminal history background check is required before the temporary license will be granted.

2. You must pay to the Board, in addition to the fees previously identified, a temporary license fee of $20 (total $335).

3. You must take and pass the MPJE-Iowa Edition before expiration of your temporary license.

If you are unable to schedule and complete the MPJE-Iowa Edition before the expiration of the 3-month temporary license, you may have the option to renew your temporary license for another 3-month period. A temporary license is limited to one renewal.

If you fail to pass the MPJE-Iowa Edition during the initial 3-month period of the temporary license, you may not continue to practice pharmacy in Iowa following expiration of the temporary license and you will not be permitted to renew the temporary license.

Initial Pharmacist License by License Transfer

Background Check

1. Once your completed applications (NABP and Board) and payments of the appropriate nonrefundable fees are received and processed, a fingerprint packet will be mailed to you at the mailing address indicated on your application. The fingerprint packet is to be promptly completed and returned to the Board for processing.

2. To ensure the efficiency and timeliness of the background check process, be sure that the mailing address you provide on your application is current (where you regularly receive and check for mail).

3. Neither a temporary nor permanent license to practice pharmacy in Iowa will be issued until the Board receives the complete criminal history background check report.

4. In addition to the criminal history background check, a permanent license to practice pharmacy in Iowa will not be issued until you have completed all other requirements for licensure to practice pharmacy in Iowa, including taking and passing the MPJE-Iowa Edition.

Iowa Regulations

657 Iowa Administrative Code -- Chapter 2 addresses issues relating to the initial licensure and continued licensure (including continuing education requirements following licensure) of individuals practicing pharmacy in Iowa.

Have you reviewed and do you understand the Iowa regulations pertaining to pharmacist licensure in Iowa?

Yes

Military or Veteran Status

Are you active duty military?

Yes

Are you a military veteran?

Yes

Are you the spouse of an active duty military member or veteran?

Yes

Any Prior Iowa Board of Pharmacy Licensure

Have you ever been licensed or registered by the Iowa Board of Pharmacy in any capacity?

Yes

Full Name

Street Address

C S Z

License #

Pharmacist Applicant Information

Last name

First name

Middle name

Suffix

Gender

NABP E-Profile ID

If you do not have an NABP E-Profile ID number, you may create one by clicking here.

Social Security #

Date of Birth

Maiden/Previous/Other Name(s) used

Government-Issued Photo Identification :

Has your name changed since your previous license/registration with this Board?

Yes

If your name has changed since your previous license/registration with the Board, upload a copy of the legal name change document (i.e. marriage certificate, divorce decree, legal name change petition) and staff will update the information following review of your application.

Document Type

Attach Name Change Document

Primary / Permanent Address

Address Line 1

Address Line 2

Address Line 3

Country

Zip

City

State

County

Alternate 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

Contact Information

Phone Type

Primary Phone #

Will you accept text messages?

Yes

Alternate Phone Type

Alternate Phone #

Will you accept text messages?

Yes

This should be an email that is regularly reviewed – all Board communications to you will initiate via this email.

Education

Please enter all college of pharmacy education information. If more than one education record, please click “Add Education” to enter additional records.

Previous Examinations for Licensure in Other States

Please enter the following information regarding all previous pharmacy examinations taken. If you are licensed in multiple states and were required to take an exam prior to receiving those additional licenses, please click “Add Exam” to enter additional records.

Employment History

Please identify your employment history for the past three (3) years. Please click “Add Employer” to enter multiple records. If you have not been employed during the past three years, please identify your most recent employment.

Other State Licenses

Please identify all states in which you currently hold or previously held a professional license or registration of any type (i.e. RN, PA, CPhT, etc.) and identify the specific license or registration. Include the pharmacist license upon which you are basing this license transfer. Do not include driver’s licenses.

Criminal History

Have you ever been convicted of or entered a plea of guilty, nolo contendere, or no contest to any crime in any jurisdiction? 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 in addition to a personal statement regarding whether each conviction directly relates to the practice of pharmacy. Your application will not be considered complete until the entirety of this information is received by the Board

Yes

Disciplinary Actions

Have you ever had a professional license or registration, in any jurisdiction, revoked, suspended, or otherwise disciplined?

Yes

Denials or Surrenders in Lieu of Disciplinary Actions

Have you ever surrendered (in lieu of disciplinary action) or had a license or registration, in any jurisdiction, denied?

Yes

Pending Charges or Investigations

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

Yes

Preview

Please review your application and return, using the Previous button, to any page(s) that needs to be changed or corrected.
Once you click the Next button on this page you will not be able to make any changes to your application.

Confirm and Submit

I hereby swear or affirm under 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 pharmacist license. I understand that this application is a public record in accordance with Iowa Code chapter 22 and that application information is public information, subject to exceptions in federal and state law.

Signature

Date

Privacy Act Notice: Disclosure of your Social Security Number on this application is required by 42 U.S.C. § 666(a)(13) and Iowa Code chapters 252J, 261, and 272D. This number will be used in connection with the collection of child support obligations and debts owed to the State of Iowa; as an internal means to accurately identify licensees or registrants; and may be shared with taxing authorities as allowed by law, including Iowa Code § 421.18.

License/Registration Type

State Licensing Body

License/Registration number

License/Registration Status

License/Registration issue date

License/Registration expire date

College of Pharmacy

Attended From

Attended To/Graduation Date

Degree Received

Total Intern Hours

If you are a graduate of a college of pharmacy outside the United States (Foreign College of Pharmacy):

Are you FPGEC Certified?

Yes

what is your FPGEC Certification Date?

You must upload a copy of your FPGEC certificate.

Exam Type

State

NAPLEX Date

NAPLEX Score

MPJE Date

MPJE Score

Name of Employer

Type of Employer

Employer Street Address

Country

Zip

City

State

Job Title

Start Date

End Date

Currently Employed