Board of Pharmacy Emergency Applications These forms can be used by a pharmacist, pharmacist intern, or pharmacy technician emergency permit or courtesy license applicant. The emergency permit application is to be used for staffing purposes when a pharmacy is without the services of a pharmacist due to death, illness, or other emergency circumstance. The emergency courtesy license is to be used to respond to an urgent situation, which is defined in 12 AAC 52.110. Please refer to the ‘Authorized Emergency Courtesy License Activities’ document when filling out the emergency courtesy license application. Emergency PERMIT Emergency Permit, Paper Application #08-4032f, Revised 11/23/2020 Emergency Permit, Online Application Emergency Courtesy LICENSE The emergency courtesy license application will be available until June 30, 2021. Applicants seeking to provide COVID-19 immunizations after this date must apply for a permanent license. Emergency Courtesy License, Paper Application #08-4757, New 11/30/2020 Emergency Courtesy License, Online Application Authorized Emergency Courtesy License Activities Initial Applications Pharmacists, Technicians, and Interns Pharmacist Application Emergency permit applicants: download the instructions HERE. #08-4032, Revised 2/18/2021 Application of pharmacist licensure by examination, by score transfer, or by credentials through NABP. Pharmacy Intern Application #08-1468, Revised 11/19/19. Application for licensure as a pregraduate or postgraduate. License required before beginning an internship in the state. Applications submitted on or after 10/31/19 no longer require a declaration of sponsorship form to be completed. In addition, individuals wishing to practice within the scope of a pharmacy intern must be licensed in Alaska prior to engaging in an internship. Pharmacy Technician Application #08-4353, Revised 8/30/2020 License required before beginning employment as a technician. Pharmacist Collaborative Practice Application #08-4410, Revised 11/26/19. Intern Affidavit of Experience #08-4068, Revised 08/07/19. Questions? See the Guide to Obtaining Your Alaska Pharmacist License Facilities In-State Pharmacy License Application #08-4082, Revised 2/8/2021. Application of pharmacy located in the state. Pharmacy Self-Inspection Report #08-4150, Revised 03/27/19. Remote Pharmacy License Application #08-4045, Revised 12/12/19. Application for a remote pharmacy located inside the state. Remote Pharmacy Self-Inspection Report #08-4442, New 05/16/06. Wholesale Drug Distributor Application #08-1466, Revised 11/19/19. Application for facility located in the state. Wholesale Drug Distributor Self-Inspection Report #08-0098, Revised 05/05/06. Drug Room License Application #08-4185, Revised 11/19/19. Application for drug room located within an institutional facility. Drug Room Self-Inspection Report #08-4043, Revised 05/05/06. Shared Pharmacy Services Application #08-4566, Revised 01/10/12. Out-of-State New License Type FAQs To find answers to common questions regarding outsourcing facilities, third-party logistics providers (3PLs), and non-resident wholesale drug distributors, please view this New License Types FAQs document. Out-of-State Pharmacy Application #08-4200, Revised 12/14/2020. Application for an out-of-state pharmacy providing prescription drugs and devices to Alaska residents. Non-Resident Wholesale Distributor License Application (Fingerprints must accompany application.) #08-4812, Rev 12/12/19 Outsourcing Facility License Application (Fingerprints must accompany application.) #08-4813, Rev 12/12/19 Third-Party Logistics Provider License Application (Fingerprints must accompany application.) #08-4814, Rev 12/12/19 Important Information Regarding New License Types SB 37 will take effect on July 1, 2019, which will authorize licensing of third-party logistics providers, outsourcing facilities, and wholesale drug distributors located outside of the State. The Alaska Board of Pharmacy convened on June 27th to review proposed regulations to implement these new license types; however, applications will be available before October 31, 2019. Please note that an Alaska business license will be required before engaging in any business activity; however, to receive a business license, a professional license must be obtained first. Applicable NAICS business codes are provided below. After receiving a professional license in Alaska, you may call 907-465-2550 or email BusinessLicense@Alaska.gov for more information on how to obtain the proper business license. 424210 – Drug Wholesalers 423490 – Professional Equipment Wholesalers If you have questions about business licensing specifically, please call them directly at (907) 465-2550. Renewal Applications Pharmacists and Technicians Biennial Pharmacist License Renewal Application #08-4096, Revised 7/21/2020 Biennial Pharmacy Technician License Renewal Application #08-4306, Revised 7/6/2020 Facilities In-State Biennial Pharmacy License Renewal Application #08-4553, Revised 7/6/2020 Biennial Remote Pharmacy License Renewal Application #08-4552, Revised 7/6/2020 Biennial Wholesale Distributor License Renewal Application #08-4554, Revised 7/27/2020 Biennial Pharmacy Drug Room License Renewal Application #08-4097, Revised 7/6/2020 Out-of-State Biennial Out-of-State Pharmacy License Renewal Application #08-4555, Revised 7/6/2020 Biennial Third-Party Logistics Provider License Renewal Application #08-4743, Revised 7/6/2020 Biennial Outsourcing Facility License Renewal Application #08-4744, Revised 7/6/2020 Biennial Wholesale Distributor License Renewal Application #08-4554, Revised 7/6/2020 Self-Inspection Reports Pharmacy Self-Inspection Report #08-4150, Revised 7/6/2020 Remote Pharmacy Self-Inspection Report #08-4442, Revised 7/6/2020 Wholesale Drug Distributor Self-Inspection Report #08-0098, Revised 7/6/2020 Also used for outsourcing facilities/third-party logistics provider initial/renewal applications. Drug Room Self-Inspection Report #08-4043, Revised 7/6/2020 Out-of-State Pharmacy Self-Inspection Report #08-4607, Revised 7/6/2020 Miscellaneous Forms Reinstatement of a Pharmacist License Fingerprint Card Cover Sheet Job Shadowing Documentation Annual Information Update Cessation of Facility Operations Pharmacy Self-Inspection Report Pharmacist Jurisprudence Questionnaire Pharmacy Intern Jurisprudence Exam Change of Facility Manager - Incoming (Fingerprints must accompany application.) Change of Facility Manager - Outgoing Request a Fingerprint Card Change of Name, Address, and/or Duplicate License Request for License Verification Order a Wall Certificate Credit Card Authorization Form PDMP Exemption Statement for Non-Dispensing Pharmacists IHS Pharmacist State Licensure Exemption Pharmacists and Pharmacy Technicians: Do not sign or date your renewal form until you have completed your continuing education requirements. This requirement is clear in the text above the signature line on pharmacist and technician renewal forms. CEs completed after the date on your renewal form will be disregarded in an audit. The envelopes and postmark dates used for division correspondence become part of your permanent record.