Applications/Forms
Emergency Practice Notification Form
Please click here for the Emergency Practice Notification Form
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 $43.05 but is subject to change. Fingerprinting fess are paid to the state vendor; the Board does not receive or collect fingerprinting fees.
- Pharmacy Technician Applications/Forms
- Intern Pharmacist Applications/Forms
- Pharmacist Applications/Forms
- Pharmacy Applications/Forms
- Drug Distributor Applications/Forms
- Miscellaneous
- Veterans Reimbursement
- Third-Party Logistic Providers
- Drug Outsourcer
PHARMACY TECHNICIAN
Pharmacy Technician Registration Application
INTERN
Intern Pharmacist Guide (STLCoP & UMKC Students)
Intern Pharmacist Guide (Non-Missouri Students)
Intern Pharmacist Licensure Application
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
MTS Certificate Application
Pharmacist Licensure Transfer (Reciprocity)
Application for Disability Accommodation
Temporary Pharmacist License Application
PHARMACY
Rx Cares for Missouri Medication Destruction and Disposal Program Participant Application
Pharmacy Permit Application (Missouri facility)
Pharmacy Permit Application (Non-resident facility)
Non-Resident Pharmacy/Pharmacist License Verification Affidavit
Business Entity State Tax Compliance Form
Class J - Shared Services Questionnaire
New: Class R Remote Dispensing Site Application
Inspection Criteria Forms
Inspection Document Request
Classification Change Application
Change of Location Application
Name Change Application
Change of Ownership Application (Non-resident Facility)
Change of Ownership Application (Missouri facility)
Out of Business Notification
Pharmacist-in-Charge Change Application
DRUG DISTRIBUTOR
Drug Outsourcer Application
Third Party Logistics Provider
Drug Distributor License Application--Missouri facility
Drug Distributor License Application--Out-of-State facility
Business Entity State Tax Compliance Form
Drug Distributor Name Change Application
Drug Distributor Location Change Application
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
Duplicate License Request
Intern Training Pharmacy Special Site Application
Licensee Report of Discipline Compliance
Third-Party Logistic Providers
INFORMATION ON NEW LAW
3PL Application (New applicants)
Amended 3PL Application
Drug Outsourcer
INFORMATION ON NEW LAW
Drug Outsourcer Application
Amended Outsourcer Application