Board of Pharmacy

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Paper Applications/Forms

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Finger Print Instructions

The applications/forms listed below are fillable forms. Completed forms should be printed and mailed to the Board office.

Fingerprinting is handled by the state's fingerprint services vendor- IdentGo. To be fingerprinted, you have to schedule a fingerprinting appointment on the Missouri Automated Criminal History Site (MACHS) website, www.machs.mo.gov or call 844-543-9712. "Registration Number: 0003" must be provided to send your print results to the Board. The fingerprinting fee is $43.50 but is subject to change. Fingerprinting fess are paid to the state vendor; the Board does not receive or collect fingerprinting fees.

Board Fees

PHARMACY TECHNICIAN
   Pharmacy Technician Registration Application

INTERN
   Intern Pharmacist Guide (STLCoP & UMKC Students)
   Intern Pharmacist Guide (Non-Missouri Students)
   Intern Pharmacist Online License Application
   Intern School Affidavit
   Intern Site and Preceptor Application (New or Change)
   Preceptor's Affidavit of Internship Hours
   Special Site or Non-Pharmacist Preceptor Application
   Special Site/Non-Pharmacist Preceptor Notice of Employment Application

PHARMACIST
   NEW - Pharmacist Licensing FAQ for New Graduates
   Examination Application
   Examination Retake Application
   Foreign Pharmacy School Graduate Examination Application
   Foreign Pharmacy School Graduate Transfer/Reciprocity Application
   Laws Not Covered On The MPJE
   License Verification Form
   MTS Certificate Application
   Pharmacist Licensure by Reciprocity
   Pharmacy School/College Affidavit
   Application for Disability Accommodation
   Temporary Pharmacist License Application

PHARMACY
   NEW: Interim Supervising Pharmacist Form
   Business Entity State Tax Compliance Form
   Change of Location Application
   Change of Ownership Application (Missouri facility)
   Change of Ownership Application (Non-resident Facility)
   Classification Change Application
   Class J - Shared Services Questionnaire
   Compounding & Internet Activity Statement
   Name Change Application
   Non-Resident Pharmacy/Pharmacist License Verification Affidavit
   Out of Business Notification
   Pharmacist-in-Charge Change Application
   Pharmacist-in-Charge Statement
   Pharmacy Permit Application (Missouri facility)
   Pharmacy Permit Application (Non-resident facility)
   Rx Cares for Missouri Medication Destruction and Disposal Program Participant Application

DRUG DISTRIBUTOR
   Business Entity State Tax Compliance Form
   Distributor Change of Ownership
   Drug Distributor License Application (Resident & Non-Resident)
   Drug Distributor License Verificaton Affidavit
   Drug Distributor Location Change Application
   Drug Distributor Name Change Application
   Drug Distributor Out of Business Notification
   Drug Manufacturer Registrant Application
   Manager-in-Charge Statement
   Missouri Manager-in-Charge Change Application (Resident & Non-Resident)

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

Third-Party Logistic Providers
   3PL Application (New applicants)
   Change of Ownership
   3PL Name Change Application
   3PL Location Change Application
   3PL Out of Business Notification
   3PL Manager-in-Charge Change Application
   Manager In Charge Statement
   Prior Owner Affidavit

Drug Outsourcer
   Application (Drug Outsourcer)
   Business Entity State Tax Compliance Form
   Change of Ownership
   License Verification Forms (Entity & Pharmacist)
   Location Change Application
   Name Change Application
   Out-of-Business Notification
   Prior Owner Affidavit
   Supervising Pharmacist Change Application
   Supervising Pharmacist Statement