Everything a Pharmacy Needs

Every pharmacy needs a permit from the board of pharmacy in the state where it operates, and each location is permitted on its own. Many states also license out-of-state pharmacies that ship or mail prescriptions to their residents. Texas, for example, issues a Class E nonresident license to a pharmacy in another state whose primary business is dispensing prescriptions and delivering them to patients, including patients in Texas, by mail, common carrier or delivery service. Each board sets its own rules for the pharmacist-in-charge, inspections, ownership disclosure and renewals, and some require a current inspection with a nonresident application.

The National Association of Boards of Pharmacy (NABP) runs the Verified Pharmacy Program, a multistate inspection program that supplements state licensing. Boards can see a pharmacy's verified licensure details and its inspection report through NABP's information-sharing network, and when a state requires a current inspection by an approved third party, a VPP inspection may meet that requirement. We prepare the resident and nonresident applications, gather the ownership, staffing and inspection documents each board asks for, and track every permit and pharmacist license renewal from one record.

A pharmacy that dispenses controlled substances needs a DEA registration. Federal rules require a separate registration for each principal place of business where controlled substances are dispensed, so each location registers on its own. Retail pharmacies register in DEA's dispensing category, which renews every three years.

We prepare the DEA application for each location, keep the registration details current, and renew each registration before it lapses.

A pharmacy needs an organizational (Type 2) NPI before it can bill. It also has an NCPDP ID, the unique number the National Council for Prescription Drug Programs assigns to each licensed pharmacy, which payers and pharmacy benefit managers use to identify it. Keeping the information behind these numbers accurate, including ownership, hours, services and permits, matters because PBMs and plans check it when they credential and pay you.

We set up the NPI and the rest of your business registrations in the order that keeps the pharmacy from waiting, coordinate entity formation and ownership questions with your attorney and accountant, and keep every identifier current when something changes.

A pharmacy is paid through the networks run by pharmacy benefit managers and health plans. Each network has its own credentialing application, its own requirements for permits, insurance, staffing and policies, and its own contract. Medicare Part D plans and many Medicaid managed care plans contract through these networks, state Medicaid programs have their own pharmacy enrollment, and specialty networks may ask for accreditation.

We build the list of networks that matter for your patients, prepare and submit each application, answer the network's follow-up questions, and track every application until it is approved. Before you sign, we review each network contract for reimbursement terms, audit rights and termination, and explain the terms that matter in plain English.

A pharmacy that supplies durable medical equipment, prosthetics, orthotics or supplies (DMEPOS) to Medicare patients, such as diabetic testing supplies, enrolls with Medicare as a DMEPOS supplier on the CMS-855S, separately from any other enrollment. Most DMEPOS suppliers must be accredited by a CMS-approved accreditation body. NABP, for example, offers a CMS-approved DMEPOS accreditation for pharmacies.

An established pharmacy can be exempt from DMEPOS accreditation if it meets all three of CMS's criteria: it has been enrolled as a DMEPOS supplier for at least five years, it has had no unrescinded final adverse action in the past five years, and its Medicare DMEPOS billing, other than drugs, is less than 5% of its pharmacy sales for the previous three calendar or fiscal years. A newly enrolling pharmacy cannot meet the five-year test, so it needs accreditation. If a pharmacy drops its accreditation and turns out not to qualify for the exemption, its Medicare billing privileges can be revoked.

We prepare the DMEPOS enrollment and help you assemble what the accreditation survey asks for. Claims for supplies carry their own documentation rules, and we work with your team so orders and proof of delivery are in place before claims go out.

Specialty pharmacies often seek accreditation to qualify for payer, manufacturer and network contracts. URAC's Specialty Pharmacy Accreditation is open to licensed pharmacies in good standing in the United States that dispense specialty medications and provide patient management services, and URAC presents it as a way to stand out in contracting with payers and manufacturers.

NABP also accredits community, compounding, digital, home infusion therapy and specialty pharmacies, and its specialty accreditation is recognized by Optum Rx's specialty pharmacy network. Each program has its own standards, and the right choice depends on what your payers, PBMs and manufacturers require. We help you compare them against your contracts, write the policies the standards ask for, and organize staff training and records for the survey.

A pharmacy that bills health plans electronically is a HIPAA covered entity. Our program covers your security risk assessment across the pharmacy system, point of sale, delivery and refill apps, written privacy and security policies, a Notice of Privacy Practices for the counter and your website, staff training with completion records, business associate agreements with every vendor, and a breach response plan.

Mail-order and delivery pharmacies have more places for information to leak: shipping labels, courier vendors, text and email refill reminders, and websites with analytics and ad pixels. We review each one, so patient information goes only where it should and never reaches an ad platform.

Opening a pharmacy means lining up steps that depend on each other: the entity and ownership structure, the location, the state permit and its inspection, the DEA registration, the NPI and NCPDP ID, and then network credentialing, which takes the longest and cannot be finished until the permits are in hand. We build the timeline from the longest steps backward and work through it with you, so the pharmacy can bill its networks as soon as it opens its doors.

Entity formation, leases and ownership agreements are handled alongside your attorney and accountant. Adding a location, a new state or a new service line such as mail order, DMEPOS or specialty follows the same plan: every permit, registration, enrollment and network change identified up front and filed in the right order.

For cash sales, our payment processing accepts cards, HSA and FSA cards and ACH, and our marketing team can build the website, local search presence and review program that bring new patients to the counter.