Get Az Application For Hospital Pharmacy Permit

This guide provides clear, step-by-step instructions on how to complete the Arizona Application for Hospital Pharmacy Permit online. Whether you are a new applicant or making changes to an existing permit, following these instructions will help ensure a smooth application process.

Follow the steps to accurately complete your application online.

1. Click the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Select the physical location of your pharmacy by choosing either 'Resident' or 'Non-Resident.' This selection will tailor the application requirements based on your pharmacy type.
3. Complete the business information section, including the business name, street address, mailing address, phone number, and email address. Make sure all details are accurate to avoid communication issues.
4. Provide ownership information, including the names and addresses of the owners or officers. If applicable, state whether there has been a change in ownership, and provide the former owner's details.
5. In the 'Other Business Information' section, include details such as the date your business opened, the pharmacy square footage, the number of beds, and the name of the hospital manager.
6. Answer the regulatory questions regarding any legal issues related to the ownership or operation of the pharmacy. Attach any required documents if you answer ‘Yes’ to any of the questions.
7. If you have designated a Pharmacist in Charge (PIC), provide their name and license information. If you have not designated one, indicate 'No.'
8. Review your application carefully for accuracy and completeness. Once you are satisfied, confirm your understanding of the provided statutes and rules by checking the affirmation box.
9. Sign and date the application to certify that all content is truthful and correct before submitting.
10. After submission, save a copy of the application for your records. You may also have the option to download or print the form.

Complete your application online today to ensure a timely review by the Arizona State Board of Pharmacy.