Get La Form 58 2022-2025

This guide provides clear and detailed instructions on completing the LA Form 58 online for the renewal of a Louisiana pharmacy permit. Whether you are a pharmacy owner or manager, this step-by-step process ensures you can successfully navigate the form.

Follow the steps to complete the LA Form 58 online

1. Click the ‘Get Form’ button to access the LA Form 58 and open it for editing.
2. Begin with Section 1, providing your pharmacy name, permit number, physical address, city, state, ZIP code, and email address. Ensure your email is accurate as it may be used for official communication.
3. Complete the NABP eProfile number if applicable. Then, respond to the special survey questions regarding your compounding practices and shipping practices by selecting 'Yes' or 'No' for each statement.
4. Proceed to Section 2, where you will answer questions regarding vacancies at your pharmacy for pharmacists and certified pharmacy technicians, indicating the number of vacant positions if applicable.
5. In Section 3, disclose any relevant disciplinary history. If your pharmacy has experienced any issues, ensure you attach a letter of explanation and a certified copy of any disciplinary actions.
6. Move to Section 4 to calculate your total fees. Make sure to include the pharmacy renewal fee, PMP fee, pharmacy education support fee, and total due. If opting out of the education support fee, check the corresponding box.
7. Finally, in Section 5, the Pharmacist-in-Charge must provide their name, sign the form, and date it to certify that all information given is true and complete.
8. Once you have completed all sections, save your changes and consider downloading, printing, or sharing the completed form for your records.

Complete your LA Form 58 online today for a smooth renewal process.