PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE SUBMITTING AN APPLICATION

How to Apply for a Distributor License:

Submit:

• Completed, signed and notarized Application for Distributor Permit.

Note: Answer all questions completely. The application must be legible.

• Non-refundable processing fee by check or money order made payable to the “State of Delaware”.
• Distributor License Verification Affidavit to the licensing agency for the state in which the facility is located. When completed by the licensing agency, submit to the Delaware Board of Pharmacy.

If controlled substances are involved, you must also submit Biennial Registration/Renewal Application for Controlled Substances Act application.

Distributor Change of Ownership or Change of Address

Submit:

• Completed, signed and notarized Application for Distributor Permit.
• Non-refundable processing fee by check or money order made payable to the “State of Delaware”.
• Distributor License Verification Affidavit to the licensing agency for the state in which the facility is located. When completed by the licensing agency, submit to the Delaware Board of Pharmacy.
• Letter notifying the Board of the change of ownership or address change. The letter should include the distributor’s current Delaware Board of Pharmacy license number and the effective date of the change.

If controlled substances are involved, you must also submit a new submit a new Biennial Registration/Renewal Application for Controlled Substances Act application.

Reporting a Distributor Name Change

Submit:

• Letter notifying the Board of the change. The letter should include:
• distributor name
• license number
• old information
• new information
• effective date of the change
• Duplicate license fee by check or money order made payable to the “State of Delaware.” The duplicate license will reflect the new name.