Board of Pharmacy

Facility Forms

Forms for Facilities in the State of Alaska

• Change of Pharmacy Manager Notice #08-4064, Revised 04/02/12.
• Pharmacy License Application #08-4082, Revised 05/15/14. Application of pharmacy located in the state.
• Pharmacy Self-Inspection Report, #08-4150, Revised 04/05/14. Print in landscape format.
• Remote Pharmacy License Application #08-4045, Revised 05/15/14. Application for a remote pharmacy located inside the state.
• Remote Pharmacy Self-Inspection Report #08-4442, New 05/08/06.
• Drug Room License Application #08-4185, Revised 05/15/14. Application for drug room located within an institutional facility.
• Drug Room Self-Inspection Report #08-4043, Revised 05/05/06.
• Wholesale Drug Distributor Application #08-1466, Revised 05/15/14. Application for facility located in the state.
• Wholesale Drug Distributor Self-Inspection Report, #08-0098, Revised 05/05/06.