Board of Pharmacy

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 $41.75 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 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 by Reciprocity
   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
   Name Change Application
   Non-Resident Pharmacy/Pharmacist License Verification Affidavit
   Out of Business Notification
   Pharmacist-in-Charge Change Application
   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
   Drug Distributor License Application--Missouri facility
   Drug Distributor License Application--Out-of-State facility
   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
   Drug Outsourcer Application
   Manager-in-Charge Change Application--Missouri facility
   Manager-in-Charge Change Application--Out-of-State facility
   Third Party Logistics Provider

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)
   3PL Name Change Application and Drug Outsourcer Name Change Application
   3PL Location Change Application and Drug Outsourcer Location Change Application
   3PL Out of Business Notification and Drug Outsourcer Out of Business Notification
   3PL Manager-in-Charge Change Application

Drug Outsourcer
   INFORMATION ON NEW LAW
   Drug Outsourcer Application
   Supervising Pharmacist Change Application