Businesses and Facilities

PIC Change

QUICK PIC
Introducing... the new BA-50 PIC Change Form!

A quick and easy way to change just your pharmacy or facility PIC, ensure compliance with all Board notifications and inventory requirements, and request an extension, if needed.

Applications

Use the following Applications on our Forms Page to apply for a new registration or request a change in name, location or ownership for your existing registration:

BA-02 Pharmacy (Resident)
BA-04 Manufacturer (in state)
BA-05 Distributor (cs, prescription drugs, and oxygen)
BA-06 Nonprescription Drug Distributor
BA-07 Research/Teaching Institution (in state)
BA-08 Analytical Lab (in state)
BA-09 Ambulance/EMS (in state)
BA-10 Retail Dealer (in state)
BA-11 Health Department or Clinic (in state)
BA-12 Institutional Drug Room (in state)
BA-15 Sample Distributor
BA-16 Durable Medical Equipment
BA-22 Non-Resident Pharmacy

Inspection Forms

Helpful Forms, Links and Tools

Use our FORMS Page to access the following:

BA-50 Change in PIC (use if only changing PIC)
   
S-300 Disciplinary History (for facilities and businesses)
C-500 CQI Meeting Report Form
   
S-310 Partnership
S-320 LLC Ownership
S-330 Corporate Ownership

Other Forms and Resources