Changes to a Facility License (Includes Resident and Nonresident)
Pharmacy, Remote Dispensing Site Pharmacy, Sterile Compounding Pharmacy, Hospital Pharmacy/Drug Room, Licensed Correctional Pharmacy, Outsourcing Facility
A Change of Permit must be submitted to the board within 30 days when one of the following changes occurs:
Notes: A Change of Permit is not required when there is a change to board members. A separate Change of Permit application and fee must be submitted for each separate license. This includes a sterile compounding pharmacy attached to a license.
- Address Correction (this includes change of street name or number made by the United States Postal Service, government entity, suite number, etc) Does NOT include a change of location.
- Change of Tradestyle Name or Corporate Name (not a change of ownership)
- Change of Administrator
- Change of Consulting Pharmacist (Drug Room)
- Warden (Licensed Correctional Facility)
- Change of Corporate Officers
- Transfer of 10% to 49% of Ownership
Change of Permit Application (17A-12) Please allow four to six weeks for processing the application.
Change of Pharmacist-in-Charge
Clinics
A Change of Permit must be submitted to the board within 30 days when one of the following changes occurs:
Note: A Change of Permit is not required when there is a change to board members. A separate Change of Permit application and fee must be submitted for each separate license.
- Address Correction (this includes change of street name or number made by the United States Postal Service, government entity, suite number, etc) Does NOT include a change of location.
- Change of Tradestyle Name or Corporate Name (not a change of ownership)
- Change of Administrator
- Change of Professional Director
- Change of Consulting Pharmacist
- Chief Executive Officer (Correctional Clinics)
- Change of Corporate Officers
- Transfer of 10% to 49% of Ownership
Change of Permit Application (17A-118) Please allow four to six weeks for processing the application.
Wholesaler, Third-Party Logistics Provider, Veterinary Food Animal Drug Retailer, Hypodermic Needle and Syringe
A Change of Permit must be submitted to the board within 30 days when one of the following changes occurs:
Note: A Change of Permit is not required when there is a change to board members. A separate Change of Permit application and fee must be submitted for each separate license.
- Address Correction (this includes change of street name or number made by the United States Postal Service, government entity, suite number, etc) Does NOT include a change of location.
- Change of Tradestyle Name or Corporate Name (not a change of ownership)
- Change of Corporate Officers
- Transfer of 10% to 49% of Ownership
Change of Permit Application (17A-52) Please allow four to six weeks for processing the application.
Change of Designated Representative-in-Charge or Responsible Manager
ADDS: Includes: Automated Drug Delivery System (ADD), Automated Patient Dispensing System (ADC), or an Emergency Medical Services Automated Drug Delivery System (ADE) license. All referred above as ADDS.
A Change of Permit must be submitted to the board within 30 days when one of the following changes occurs:
Note: A separate Change of Permit application and fee must be submitted for each separate license.
- Address Correction of the facility where the ADDS is located. (Not a physical change of location of the ADDS). This ONLY includes a change made by the United States Postal Service to the facility the ADDS is located.
- Change of Facility Name where the ADDS is located. (Does not include a change of ownership of the primary responsible pharmacy.)
Change of Permit Application (17A-117) Please allow four to six weeks for processing the application.