Changes to a Facility License
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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 separate Change of Permit application and fee must be submitted for each separate license.
- Address Update (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. If the sterile compounding pharmacy license is requiring a change in addition to the primary license, include a Change of Permit application for the sterile compounding pharmacy license and fee.
- Change of Tradestyle Name or Corporate Name (not a change of ownership). If the sterile compounding pharmacy license is requiring a tradestyle name change in addition to the primary license, include a Change of Permit application for the sterile compounding pharmacy license and fee.
- Change of Administrator
- Change of Consulting Pharmacist (Drug Room)
- Warden/Chief Executive Officer (Licensed Correctional Facility)
- Change of Natural Person(s): Officer/Manager/Trustee/Director
- Transfer of 10% to 49% of Ownership
Change of Permit Application (17A-12) Please allow 30 days 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 separate Change of Permit application and fee must be submitted for each separate license.
- Address Update (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 Natural Person(s): Officer/Manager/Trustee/Director
- Transfer of 10% to 49% of Ownership
Change of Permit Application (17A-118) (PDF)Please allow 30 days for processing the application.
Change of Professional Director (17A-112) (PDF)
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 separate Change of Permit application and fee must be submitted for each separate license.
- Address Update (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 Natural Person(s): Officer/Manager/Trustee/Director
- Transfer of 10% to 49% of Ownership
Change of Permit Application (17A-52) Please allow 30 days 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.