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Today is: Thursday, June 20, 2013
Application and Fees
Change form for licenses(address, name, employment)
Change form for Permit (business name, address, responsible party(not Pharmacist in charge change)
Controlled Substance Registration-Facility
$50.00
Controlled Substance Registration-Pharmacist
$50.00
Duplicate Certificate (include written request with fee)
$25.00
Duplicate Wallet Card (include written request with fee)
$15.00
Emergency Medication Kit (IEMK)
$50.00
Extern/Intern (PHARMACY STUDENT) Controlled Substance Registration
$50.00
Home Health/Hospice Permit
$50.00
Initial Pharmacist License(NOT FOR TRANSFER)
$100.00 License Fee + $50.00 Controlled Substance Fee (if applicable) and $40.00 Background Check Fee
Medical Equip. Suppliers Permit
$150.00
Medical Gas Wholesaler
$50.00
Non-Resident Facility
$300.00
Pharmacist License Renewal
$105.00
Pharmacist in Charge Change
$300
Pharmacy Benefit Manager Application
$500.00
Pharmacy Permit and Pharmacy Controlled Substance Registration
$350.00
Preliminary Application for License Transfer
$200.00 License fee + $40.00 Background Check Fee + $50.00 Control Substance Fee(if applicable)= $290.00 TOTAL
Pharmacy Technician Application
$50.00 Registration Fee + $40.00 Background Check Fee = $90.00 TOTAL
Wholesaler Permit (In State and Out of State)
$500.00