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Facility Forms
| Facilities
Located in the State of Alaska: |
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Pharmacy
License Application #08-4082, Revised 05/16/06.
Application of pharmacy located in the state. |
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Change
of Pharmacy Manager Notice #08-4064, Revised 02/13/07. |
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Remote Pharmacy License Application #08-4045, Revised 05/16/06. Application for a remote pharmacy located inside the state. |
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Pharmacy
Self-Inspection Report, #08-4150, Revised
05/08/06. Print in landscape format. |
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Remote Pharmacy Self-Inspection Report #08-4442, New 08-4442. |
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Drug
Room License Application #08-4185, Revised 05/12/06. Application for drug room located
within an institutional facility. |
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Drug
Room Self-Inspection Report #08-4043, Revised
05/05/06. Print in landscape format. |
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Wholesale
Drug Distributor Application #08-1466,
Revised 05/12/06. Application for facility located
in the state. |
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Wholesale
Drug Distributor Self-Inspection Report,
#08-0098, Revised
05/05/06. Print in landscape
format. |
| Facilities
Located Outside of the State of Alaska: |
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Out-of-State
Application #08-4200, Revised 05/12/06. Application
of out-of-state pharmacy providing prescription
drugs and devices to Alaska residents. |
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Out-of-state
Wholesale Drug Distributor #08-4344, Revised 02/01. Information on registration requirements
for Wholesale Drug Distributors located outside
Alaska. |
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Applications
may be
viewed and printed
with Adobe
Acrobat
Reader
6.0 or
higher. If you
do
not have
Adobe Acrobat
Reader
6.0 or higher,
please
click
on the
Adobe logo and
download
the free
software
now. If
you
are unable
to view
or download
an application,
please
contact us by
telephone
or e-mail.
Providing
your complete
mailing
address will
enable
us to mail
you the
application. Other
application
forms
may be mailed
to you
or picked up
at a
division
office.
Completed applications
must
be signed
and submitted
to the
division with
the
appropriate
fees. |
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