Applications & Fees
To access any application listed below, please visit the Licensing Gateway.
| Application | Fees |
|---|---|
| Amendment Form For License or Registration (For individuals- address, name, employment) | No Fee |
| Amendment Form For Permit (In-State and Out of State- business name, address, responsible party) (Not Pharmacist in charge change) | Additional Application Fee Applies |
| Compounding Certificate Application (This application is designed to be a fillable form for your convenience; however, an original signature will be required.) | No Fee |
| Controlled Substance Registration Only (Facilities) | $50.00 |
| Drug Facility Permit (In-State and Out of State) | $500.00 |
| Emergency Medication Kit (IEMK) (In-State only) | $100.00/$300.00 |
| Extern/Intern (PHARMACY STUDENT) Controlled Substance Registration | $50.00 |
| Home Health/Hospice Permit (In-State Only) | $50.00 |
| Initial Pharmacist License (For individuals taking the Naplex to obtain) (NOT FOR TRANSFER) | $100.00 License Fee + $50.00 Controlled Substance Fee (if applicable) + $40.00 Background Check Fee |
| Medical Equip. Suppliers Permit (In-State and Out of State) | 150.00 |
| Medical Gas Wholesaler (In-State and Out of State) | $50.00 |
| Outsourcer (In-State and Out of State) | $300.00 + $50.00 (Controlled Substance if applicable) |
| Pharmacist License Renewal | $105.00 |
| Pharmacist in Charge Change | $300.00 |
| Pharmacy Benefit Manager Application for License | $500.00 |
| Pharmacy Permit and Pharmacy Controlled Substance Registration (In-State and Out of State) | $350.00 |
| Physician Dispensing Permit | $350.00 |
| Preliminary Application for License Transfer (For individuals who hold a current pharmacist license in another state) | $200.00 License fee + $40.00 Background Check Fee + $50.00 Control Substance Fee (if applicable) = $290.00 TOTAL |
| Pharmacy Services Permit (For professional consulting services and outpatient surgery centers) | $100.00 |
| Pharmacy Technician Application | $50.00 Registration Fee + $40.00 Background Check Fee = $90.00 TOTAL |
| Unused/Unneeded Medication Donation Permit | No Fee |
| Background Check Processing | $40.00 |