Board of Pharmacy

Applications and Forms

The forms listed below are fillable forms. Open the form, type the application information, and print. You should then sign the form and have notarized, if applicable. If your computer does not allow completion of the form online, you may print the blank form and complete the application information in black ink.

Effective July 1, 2012, 3M/Cogent is the state's new fingerprint services vendor. Applicants should schedule a fingerprinting appointment on the Missouri Automated Criminal History Site (MACHS) website, www.machs.mo.gov or call 877-862-2425. "Registration Number: 0003" must be provided. The fingerprinting fee is $44.80. To learn more about the new fingerprint process, click here.

Specific portions of the fingerprinting fee are paid to the Missouri State Highway Patrol, the FBI, and 3M/Cogent; the Board does not receive any portion of the fingerprinting fee.

PHARMACY TECHNICIAN
   Pharmacy Technician Registration Application

INTERN
   Intern Pharmacist Guide
   Intern Pharmacist Licensure Application
   Intern Site and Preceptor Application (New or Change)
   Preceptor's Affidavit of Internship Hours
   Special Site or Non-Pharmacist Preceptor
   Special Site/Non-Pharmacist Preceptor Notice of Employment Application

PHARMACIST
   Foreign Pharmacy School Graduate Examination Application
   Foreign Pharmacy School Graduate Transfer/Reciprocity Application
   Laws Not Covered On The MPJE
   MTS Certificate Application
   Pharmacist Examination Application
   Pharmacist Examination Retake Application
   Pharmacist Licensure Transfer (Reciprocity)
   Temporary Pharmacist License Application

PHARMACY
   Business Entity State Tax Compliance Form
   Class J - Shared Services Questionnaire
   Inspection Criteria Forms
   Non-Resident Pharmacy/Pharmacist License Verification Affidavit
   Out of Business Notification
   Pharmacy Class B Classification Change Only
   Pharmacy Classification Change Application
   Pharmacy Location Change Application
   Pharmacy Name Change Application
   Pharmacy Permit Application (Missouri facility)
   Pharmacy Permit Application (Non-resident facility)
   Pharmacist-in-Charge Change Application

DRUG DISTRIBUTOR
   Business Entity State Tax Compliance Form
   Drug Distributor Name Change Application
   Drug Distributor Location Change Application
   Drug Distributor License Application--Missouri facility
   Drug Distributor License Application--Out-of-State facility
   Drug Distributor Out of Business Notification
   Drug Distributor License Verificaton Affidavit
   Drug Manufacturer Registrant Application
   Manager-in-Charge Change Application--Missouri facility
   Manager-in-Charge Change Application--Out-of-State facility

MISCELLANEOUS
   Application for Approval of Pharmacist Continuing Education Program
   Continuing Education Program Instruction Sheet
   Duplicate License Request
   Intern Training Pharmacy Special Site Application
   Licensee Report of Discipline Compliance