Department of Inspections, Appeals, and Licensing

amanda.woltz@dia.iowa.gov

6200 Park Ave., Ste. 100 Des Moines, IA 50321

515.281.6674

Technician Product Verification Program Initiation Notification

Please complete this notification form as well as update the information in the pharmacy's online profile under Pharmacy Practice/Services.

Pharmacy Name

Iowa License No

Is the pharmacy implementing a previously discontinued TPV program?

Yes

What step(s) in the prescription filling process utilize(s) barcode scanning?

Pharmacist hours per week

Checking technician hours per week

Training program for checking technicians

Yes

Quarterly quality assurance program procedure

Yes

Redirection of pharmacist hours to clinical pharmacy services

Yes

Identification of drug products which will not be allowed to be verified under TPV

Yes

If no to any of the above, please explain

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First Name

Last Name

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