PLEASE READ THE FOLLOWING INSTRUCTIONS CAREFULLY BEFORE SUBMITTING THE APPLICATION

Note: Answer all questions completely and legibly.

How to Apply for a New License for a Pharmacy Not Located in Delaware

Submit:

• Completed, signed and notarized Application for Non-Resident Pharmacy Permit.
• Non-refundable processing fee by check or money order made payable to the “State of Delaware.”
• Sample patient profile that meets the requirements of Section 5.0 of the Board’s Rules and Regulations.

When the application is complete, the Executive Secretary of the Board will review the application. If approved, the Board office issues the license.

If controlled substances are involved, you must also submit an controlled substances application.

Reporting Non-Resident Pharmacy Change of Ownership

You are required to report a change of ownership of a non-resident pharmacy. Submit:

• New completed, signed and notarized Application for Non-Resident Pharmacy Permit.
• Non-refundable processing fee by check or money order made payable to the “State of Delaware.”
• Sample patient profile that meets the requirements of Section 5.0 of the Board’s Rules and Regulations.

When the application is complete, the Executive Secretary of the Board will review the application. If approved, the license will be issued, and the license number will remain the same.

If controlled substances are involved, you must also submit a new controlled substances application.

Reporting Non-Resident Pharmacy Change of Address or Name

Submit:

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