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Get Pa 854 143 2015
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How to fill out the PA 854 143 online
The PA 854 143 form is essential for nonresident pharmacies seeking registration in Pennsylvania. This guide will provide you with clear, step-by-step instructions to fill out the form online, ensuring a smooth submission process.
Follow the steps to complete the application successfully.
- Press the ‘Get Form’ button to access the PA 854 143 document in your online editor.
- Select the transaction type by checking the appropriate box for either a new nonresident pharmacy registration or a change in status. Ensure you are aware of the associated fees, which vary based on the selected transaction.
- Enter the name of the pharmacy as registered in your resident state at the designated field.
- Input the pharmacy permit/license number issued in your resident state and provide the pharmacy's address including street, city, state, and zip code.
- If applicable, provide details related to changes in location, owner, or pharmacist in charge by filling out the relevant sections completely, including previous details and effective dates.
- For the pharmacist in charge section, include the printed name, address, resident state license number, and specific dates for both the current and former pharmacist in charge.
- Fill in the ownership information by checking the type of pharmacy ownership and providing the owner's name and Federal Employer Identification Number (FEIN). Include the names and addresses of any principal officers as needed.
- Address any disciplinary history related to the nonresident pharmacy by indicating if there has been any disciplinary action and providing necessary documentation if applicable.
- Complete the verification statement. Ensure all declarations are accurate and provide necessary signatures and dates from both the pharmacist in charge and the authorized representative.
- After all fields are filled out, you can save changes, download the form, print it, or share it as needed.
Start filling out the PA 854 143 online to complete your nonresident pharmacy registration efficiently.
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You should send articles of dissolution to the Pennsylvania Department of State, Bureau of Corporations and Charitable Organizations. Ensure that you use the correct mailing address listed on their official website. It's essential to retain a copy of your filing for your records. For more structured advice, refer to the PA 854 143 guidelines.
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