Get Fee Doubles 15 Days

Filling out the Fee Doubles 15 Days form is a crucial step for maintaining compliance with the Oklahoma State Board of Pharmacy. This guide provides a clear and supportive walkthrough to ensure that users can complete the form accurately and efficiently.

Follow the steps to complete your form successfully.

1. Press the ‘Get Form’ button to obtain the Fee Doubles 15 Days form and open it in your preferred editor.
2. Begin by entering the expiration date in the designated field. This date is important for establishing the time frame for your renewal.
3. Fill out the name and/or doing business as (dba) along with the street address of the facility. Ensure clarity and accuracy in your entries.
4. Provide the permit number in the corresponding field to identify your current permit status.
5. If applicable, complete the mailing address section. This is where you will receive correspondence regarding your permit.
6. Indicate any changes by checking the relevant boxes for name, ownership, or address changes. This assists the board in processing your application correctly.
7. In the prescription items section, check all applicable options regarding the types of medications sold or shipped to Oklahoma.
8. Describe your business practice by checking all relevant boxes that apply to your operations at this location.
9. Complete the facility manager's details, including their name, phone number, email address, and facility hours.
10. Specify the type of ownership by selecting one of the options provided: individual, partnership, or corporation.
11. If applicable, provide the state of incorporation for your business.
12. List the individual owners, partners, or corporate officers associated with your facility. If additional space is needed, attach a separate page.
13. Answer whether there have been any arrests, charges, or convictions in the last 15 months regarding the manager or owner. If 'yes', provide details on a separate page.
14. Confirm if the facility listed is located in Oklahoma. If not, attach a copy of the license issued by the resident state.
15. Provide the name and title of the person responsible for the application and include a signature and date.
16. Review all information carefully to ensure accuracy. Once confirmed, save your changes, download, print, or share the completed form as needed.

Complete your Fee Doubles 15 Days form online now to ensure timely processing and avoid potential complications.