Follow the steps to complete the change notification form accurately.

1. Press the ‘Get Form’ button to acquire the form and open it in your editor.
2. Begin by entering the pharmacy's legal name in the section labeled ‘Current - Legal Name’. If applicable, update the new legal name alongside it under the ‘New - Legal Name’ section.
3. If there is a change in the ‘Doing Business As’ (DBA) name, input the current DBA name and the new DBA name in the designated fields, ensuring accuracy.
4. Update the current address of the pharmacy and provide the new address in the respective fields. It is important to ensure all address components, including city, state, and ZIP code, are entered correctly.
5. If applicable, include your phone number, fax number, and email address in the appropriate sections to maintain communication.
6. Complete the required supporting documents depending on the type of change (e.g., new address, name change) as specified in the instructions. Ensure you include copies of the home state license and, if applicable, an inspection report.
7. If you are notifying the Board of pharmacy closure or surrender, clearly indicate the closure date and ensure you submit the original SD license.
8. Sign the form as a representative of the pharmacy, print your name, and provide contact information under the signature section.
9. Review all entries for accuracy one last time. Once confirmed, you can save changes, download the completed form, print it, and prepare it for submission to the Board.

Take the necessary steps to ensure your pharmacy’s compliance by completing the form online today.