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State of Alaska >Commerce >Professional Licensing > Board of Pharmacy    > Facility Forms
 
Facility Forms
Facilities Located in the State of Alaska:
Pharmacy License Application #08-4082, Revised 05/16/06. Application of pharmacy located in the state.
Change of Pharmacy Manager Notice #08-4064, Revised 02/13/07.
Remote Pharmacy License Application #08-4045, Revised 05/16/06.  Application for a remote pharmacy located inside the state.
Pharmacy Self-Inspection Report, #08-4150, Revised 05/08/06. Print in landscape format.
Remote Pharmacy Self-Inspection Report #08-4442, New 08-4442.
Drug Room License Application #08-4185, Revised 05/12/06. Application for drug room located within an institutional facility.
Drug Room Self-Inspection Report #08-4043, Revised 05/05/06. Print in landscape format.
 Wholesale Drug Distributor Application #08-1466, Revised 05/12/06. Application for facility located in the state.
Wholesale Drug Distributor Self-Inspection Report, #08-0098, Revised 05/05/06. Print in landscape format.
Facilities Located Outside of the State of Alaska:
Out-of-State Application #08-4200, Revised 05/12/06. Application of out-of-state pharmacy providing prescription drugs and devices to Alaska residents.
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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