Compliance Inspection Report Page 11

Inspection Completion

Exit Interview

I have participated in a pharmacy Compliance Inspection and have reviewed the Compliance Inspection Report with the Investigator(s). The pharmacist Manager of Record

will provide a plan of correction for all observed deficiencies within 15 business days.

Print Name:

Signature:

Title:

License Number:

Investigator Signatures

Investigator:

Date:

Investigator:

Date:

The deficiencies cited in this Compliance Inspection Report are not intended to be an all-inclusive list of deficiencies that exist at this Registrant facility. The pharmacy and the

pharmacist Manager of Record are responsible for investigating and determining the causes of the deficiencies identified and for preventing their recurrence and the

occurrence of other deficiencies. All licensees are responsible for complying with state and federal laws and regulations governing the practice of pharmacy.