Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the application by providing the name and mailing address of the pharmacy, along with contact information such as phone, fax, and email.
3. Indicate your legal organization type (corporation, partnership, individual, etc.) and list the names, dates of birth, and addresses of all owners or partners.
4. Fill in the license numbers for all pharmacists employed by the pharmacy. Include the name of the pharmacist-manager and their license number.
5. Answer the Vermont mandatory ‘Good Standing’ declarations regarding child support, taxes, employment compensation, and any unpaid judgments.
6. Respond to the credential and fitness questions, indicating any disciplinary actions or denials that may apply to your entity.
7. Complete the affirmation forms, ensuring that all necessary signatures from the sole proprietor, partners, and corporate officers are obtained.
8. Provide any required statements from the pharmacist-manager, and include the toll-free number for your pharmacy.
9. Attach any additional documentation, such as verification of licensure standing and the most recent inspection report, as required.
10. Review the entire application for accuracy before submitting, ensuring that all necessary fields are filled out and all required signatures are obtained.
11. Once everything is complete, save your changes, download a copy of the form, and print it for your records or to share with the appropriate board.

Start your application process online today to ensure timely licensure for your pharmacy.