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 Initial Applications Pharmacists, Technicians, and Interns Pharmacist Application Emergency permit applicants: download the instructions HERE. #08-4032, Revised 02/18/2021 Application of pharmacist licensure by examination, by score transfer, or by credentials through NABP. Pharmacy Intern Application #08-1468, Revised 11/19/2019 Application for licensure as a pregraduate or postgraduate. License required before beginning an internship in the state. Applications submitted on or after 10/31/2019 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 08/30/2020 License required before beginning employment as a technician. Pharmacist Collaborative Practice Application #08-4410, Revised 11/26/2019 Intern Affidavit of Experience #08-4068, Revised 08/07/2019 Questions? See the Guide to Obtaining Your Alaska Pharmacist License Facilities In-State Pharmacy License Application #08-4082, Revised 02/8/2021 Application of pharmacy located in the state. Pharmacy Self-Inspection Report #08-4150, Revised 03/27/2019 Remote Pharmacy License Application #08-4045, Revised 12/12/2019 Application for a remote pharmacy located inside the state. Remote Pharmacy Self-Inspection Report #08-4442, New 05/16/2006 Wholesale Drug Distributor Application #08-1466, Revised 11/19/2019 Application for facility located in the state. Wholesale Drug Distributor Self-Inspection Report #08-0098, Revised 05/05/2006 Drug Room License Application #08-4185, Revised 11/19/2019 Application for drug room located within an institutional facility. Drug Room Self-Inspection Report #08-4043, Revised 05/05/2006 Shared Pharmacy Services Application #08-4566, Revised 01/10/2012 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, Revised 09/10/2021 Outsourcing Facility License Application (Fingerprints must accompany application.) #08-4813, Revised 12/12/2019 Third-Party Logistics Provider License Application (Fingerprints must accompany application.) #08-4814, Revised 12/12/2019 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 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. Pharmacists and Technicians Biennial Pharmacist License Renewal Application #08-4096, Revised 07/21/2020 Biennial Pharmacy Technician License Renewal Application #08-4306, Revised 07/06/2020 Facilities In-State Biennial Pharmacy License Renewal Application #08-4553, Revised 07/06/2020 Biennial Remote Pharmacy License Renewal Application #08-4552, Revised 07/06/2020 Biennial Wholesale Distributor License Renewal Application #08-4554, Revised 07/27/2020 Biennial Pharmacy Drug Room License Renewal Application #08-4097, Revised 07/06/2020 Out-of-State Biennial Out-of-State Pharmacy License Renewal Application #08-4555, Revised 07/06/2020 Biennial Third-Party Logistics Provider License Renewal Application #08-4743, Revised 07/06/2020 Biennial Outsourcing Facility License Renewal Application #08-4744, Revised 07/06/2020 Biennial Wholesale Distributor License Renewal Application #08-4554, Revised 07/06/2020 Please be advised: the Board of Pharmacy intends to extend this year’s renewal expiration date to September 30, 2022, which includes an extension for continuing education completion. Renewal forms for 2022 – 2024 will be available by mid-June. Please subscribe to the Board of Pharmacy ListServ to keep apprised of renewal updates. Please also be aware that only licensees and registrants whose license/registration lapsed in 2020 and who are needing to be renewed through 2022 (not 2024) should email BoardOfPharmacy@Alaska.Gov to request a copy of the renewal form for the previous biennium. Requests for 2020 – 2022 renewal forms for licensees/registrants who are current through June 30, 2022 will not be returned since the 2022 – 2024, which is not yet available, is what will need to be submitted. Self-Inspection Reports Pharmacy Self-Inspection Report #08-4150, Revised 07/06/2020 Remote Pharmacy Self-Inspection Report #08-4442, Revised 07/06/2020 Wholesale Drug Distributor Self-Inspection Report #08-0098, Revised 07/06/2020 Also used for outsourcing facilities/third-party logistics provider initial/renewal applications. Drug Room Self-Inspection Report #08-4043, Revised 07/06/2020 Out-of-State Pharmacy Self-Inspection Report #08-4607, Revised 07/06/2020 Miscellaneous Forms Reinstatement of a Pharmacist License #08-4225, Revised 06/25/2021 Fingerprint Card Cover Sheet #08-4828, Revised 09/10/2021 Job Shadowing Documentation #08-4569, New 01/06/2011 Annual Information Update #08-4484, Revised 03/08/2022 Cessation of Facility Operations #08-4791, New 12/12/2019 Pharmacy Self-Inspection Report #08-4150, Revised 06/18/2020 Pharmacist Jurisprudence Questionnaire #08-4096a, Revised 04/01/2018 Pharmacy Intern Jurisprudence Exam #08-1468, Revised 02/10/2010 Change of PIC/Facility Manager - Incoming (Fingerprints must accompany the application for facility managers only.) #08-4064, Revised 07/29/2021 Change of Facility Manager - Outgoing #08-4285, Revised 10/25/2019 Request a Fingerprint Card PDMP Dispensing Status Change Form for Pharmacists #08-4840, New 03/17/2022 PDMP Dispensing/Distributing Status Change Form for Pharmacies #08-4841, New 03/17/2022 PDMP Exemption Statement for Non-Dispensing Pharmacists #08-4805, Revised 02/18/2021 IHS Pharmacist State Licensure Exemption #08-4826, New 11/04/2019