Forms and Instructions

​Pharmacist Licenses/Permits Type​
Change of Pharmacist in Charge PDF​
Change of Pharmacist in Charge Extension Form ​PDF
License by Examination​ PDF​
License by Reciprocity​ PDF​
​Pharmacist License Reinstatement Form​ ​PDF
Compounding Questionnaire​ ​PDF
Nursing Home Consultant​ PDF​
Preceptor Application​ PDF​
Foreign Applicants​ PDF​
Administer Immunization Certification​ PDF​
​Interns ​Type
Intern Application​ PDF​
Intern Training Plan​ PDF​
Affidavit of Experience​ PDF​
Pharmacy Technicians​ Type​
2016 Pharmacy Technician Application​
Pharmacy Technician Reinstatement​ ​PDF
​Business Licenses Type​
Retail Pharmacy Application - In State​ PDF​
Retail Pharmacy Application - Out of State​ PDF​
Hospital Pharmaceutical Services PDF​
Institutional Pharmaceutical Services​ PDF​
Wholesale Distributor of Legend Drugs​ PDF​
Supplier of Medical Equipment, Legend Devices, and Medical Gas (DME license) PDF​
Wholesale Distributor of List I Chemicals​ PDF​
Charitable Clinic Application​ PDF​
Pharmacist in Charge Compliance Affidavit​ ​PDF
Other Forms​ ​Type
Criminial Background Check Identity Verification Form​ ​​PDF
CE Approval Request Form​ PDF​
CE Approval Request Form ​Word
Change Form​ PDF​
Closing of Pharmacy Form PDF​
Complaint Form​ PDF​
Inspection Request Form PDF​
Order Form​ PDF​
Request for Waiver Form​ PDF​
​Other Resources ​Type
Samples of protocols, authority to administer immunizations, and sample forms for
Suggested Procedures When Buying or Selling a Pharmacy ​PDF
Effects of New Federal Meth Act on Arkansas Pseudo Law ​PDF
Multidose Memorandum of Understanding ​PDF
​Shrink Report Tool​ ​Excel