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DOWNLOADS

Instructions: Click on the name of the application and it will open, then click SAVE to place it on your computer

PHARMACY
New and Renew Application

WAIVER
New and Renewal Application

NON-RESIDENT
New and Renewal Application

DISTRIBUTOR
Wholesale Distributor
Manufacturer of own Product

INSPECTION
Community Pharmacy Inspection Form

Distributor Inspection Form

Hospital Inspection Form

Long Term Care Inspection Form

Sterile Inspection

Opening Pharmacy Inspection Form

Repository Inspection Form

OTHER
Drug Repository

Donor Form

Repository Recipient

Law Book Order Form (fee)

Name Change Only

Roster Request Form


Report or view missing or stolen prescription pads - Click Here

Duplicate License Form

Written Verification Form


establ1.jpg

ESTABLISHMENT FORMS

NEW FEE INCREASES EFFECTIVE FEBRUARY 1, 2010

Pharmacies Stop! Please read the important renewal information

- Please Read This Important ** NOTICE **

- WHOLESALE DISTRIBUTOR APPLICATION

- DISTRIBUTORS MANUFACTURING THEIR OWN PRODUCT

- SAMPLE SURETY BOND and
SAMPLE IRREVOCABLE LETTER of CREDIT

- FAQs

Click the links on the left to download the application to your computer.

The Board is in the process updating the establishment forms, enter your contact information and check the appropriate box to request that a new form be mailed or emailed to you Microsoft Word.

Form Coming Soon

Submit Request For Establishment Information

Allow 7-10 days for processing

Name
Company Name
Address
City
State
Zip Code
Home Telephone #
Business Telephone #
Email the Information to
Enter "Do Not eMail" if you wish to have the information mailed to the address above. Criminal Background cards can not be emailed.

Information Requested

Pharmacy Permit Forms

New Pharmacy Application

Pharmacy Reinstatement Application

Pharmacy Change Owner/Location

Pharmacy Name Change Only Form

Pharmacy Repository / Drop-off Application

New Pharmacy Non-Resident Application

New Pharmacy Waiver Application

Distributor Permit Forms

Wholesale Distributor Application

Own-Label Distributor Application

Distributor Reinstatement Application

Distributor Change Owner/Location

Distributor Name Change Only Form

Other Forms

Criminal Background Application Only

Request Closing Inspection Form

Permit # Include if you currently have a Maryland permit

RETURN TO HOME PAGE

Board Pharmacy Pharmacist Contact Information
4201 Patterson Avenue
Baltimore, Md 21215
(410)764-2485
(410)358-6207 (fax)

Contact: Keisha Wise keisha.wise@maryland.gov

Last Updated: 12/02/2011