Get Ca 17m-45 2020-2026

This guide provides step-by-step instructions on completing the CA 17M-45 form for a community pharmacy license application online. By following these instructions carefully, users can ensure that their application is filled out accurately.

Follow the steps to complete the CA 17M-45 form effectively.

1. Use the 'Get Form' button to access the CA 17M-45. This will allow you to open the document in an editable format.
2. Begin by entering the applicant information, including the name of the pharmacy, its location, and contact details. Make sure the pharmacy name does not exceed 65 characters.
3. Select the type(s) of pharmacy from the provided options such as retail, home health care, or correctional facility. This ensures the application is tailored to the pharmacy type.
4. Indicate your application type (e.g., new pharmacy, change of ownership, temporary license request) and provide relevant dates as necessary.
5. Detail the ownership structure by selecting the appropriate type of ownership (individual, partnership, LLC, etc.) and providing the FEIN number.
6. Identify a contact person who the Board can communicate with concerning the application status. Ensure the contact person’s name and email address are accurately provided.
7. If applicable, provide information about any changes of ownership or location, including the names, addresses, and license numbers associated with the current pharmacy.
8. Complete the section on fingerprint requirements as instructed. Make sure that all necessary individuals have undergone fingerprinting as required by the Board.
9. Review all sections of the form for accuracy and completeness, ensuring that all necessary documentation is attached.
10. Once completed, save your changes and print a copy for your records. Then submit the form as directed.

Complete your CA 17M-45 form online today to ensure a smooth application process!