Get Pharmacy Application - Nh . Gov - Nh

Filling out the Pharmacy Application is a vital step for any pharmacy seeking to operate in New Hampshire. This guide offers clear, step-by-step instructions to ensure a smooth and successful application process.

Follow the steps to effectively complete your Pharmacy Application online.

1. Click ‘Get Form’ button to access the Pharmacy Application form and view it in your browser or designated editing software.
2. Review the application requirements carefully. Ensure you understand each section and gather the necessary documents, including applicable fees and identification.
3. Complete the permit application section by checking the appropriate box for the type of application—New Pharmacy, Change of Location, or Change of Ownership. Remember to include the applicable fee.
4. Fill out the pharmacy information section. Provide the pharmacy's name, street address, city or town, state (NH), telephone number, fax number, zip code, email address, DEA number, and expiration date.
5. In the pharmacist-in-charge section, input the designated pharmacist's name and home address, and confirm they agree to serve in this role.
6. Indicate the type of pharmacy you are applying for by checking the applicable box—Community Pharmacy, Hospital Pharmacy (For-Profit/Non-Profit), Home Infusion Pharmacy, or Other.
7. Select the ownership type by checking the appropriate box, whether it is Sole Proprietorship, Partnership, Corporation, or LLC. Provide any required supporting information based on your chosen type.
8. If applicable, disclose any legal proceedings or actions concerning the corporation or individuals involved in the application.
9. Specify the pharmacy hours of operation, detailing the opening and closing times for each day of the week.
10. List the pharmacists and pharmacy technicians employed at the pharmacy, including their NH license or registration numbers.
11. Describe the pharmacy's physical specifications and submit any drawings if required, ensuring compliance with the Board of Pharmacy.
12. Complete the signatures required by the chief administrative officer and the pharmacist-in-charge to finalize the application.
13. After reviewing the application for accuracy, save changes, and proceed to download, print, or share the completed form as necessary.

Start your application process online today and ensure your pharmacy is ready to serve the community!