Doh 4330-2026

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The document is a license application form from the New York State Department of Health's Bureau of Narcotic Enforcement for engaging in controlled substance activities. It includes sections for applicant information, application type (new or renewal), license classification, fees, and acknowledgments regarding compliance with laws and regulations. The form also requires details about the storage of controlled substances and supervisor information if applicable. Additionally, it addresses prior convictions and licensing issues related to controlled substances.

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Click ‘Get Form’ to open the doh 4330 in the editor.
Begin by filling out the 'Applicant Information' section. Enter your legal name, contact information, and any applicable details such as your title and address. Ensure that a street address is included if using a P.O. Box.
Select the appropriate 'Application Type' by checking either 'NEW' or 'RENEWAL'. If applicable, indicate any changes such as name or address changes.
In the 'License Classification' section, check only one box that corresponds to your business type, ensuring you understand each classification's requirements.
Complete the 'Controlled Substance Schedule(s) to be Utilized' and 'Storage of Controlled Substances' sections by checking all relevant options and providing descriptions where necessary.
If someone other than yourself will supervise controlled substance activity, fill out their information in the 'Supervisor of Controlled Substance Activity' section.
Review the applicant acknowledgments carefully before signing. Ensure all statements are true and complete.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (112 Votes)
2012	4.2 Satisfied (164 Votes)
2008	4.3 Satisfied (171 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Do I need a dea license for each state?

Thus, unless subject to an applicable exception, DEA regulations require a practitioner to obtain a separate DEA registration in each state in which he or she dispenses a controlled substance.

What is the 30 day controlled substance law in NY?

No additional prescriptions for a controlled substance may be issued by a practitioner to an ultimate user within 30 days of the date of any prescription previously issued unless and until the ultimate user has exhausted all but a seven days supply of that controlled substance provided by any previously issued

What are the 5 class categories of controlled substances?

There are established five schedules of controlled substances, to be known as schedules I, II, III, IV, and V. Such schedules shall initially consist of the substances listed in this section.

What is a level 5 controlled substance?

Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of Schedule V drugs are: cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, Parepectolin.

Who manages controlled substances?

The Controlled Substances Program (CSP) is overseen by the Deputy Center Director for Substance Use and Behavioral Health and aims to promote the public health by minimizing risks associated with problematic use of controlled substances while enabling appropriate access for medical use.

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What is a supervisor of controlled substance activity?

Supervisor of Controlled Substance Activity (Supervisors) is an individual who undertakes responsibilities including ordering, receiving, inventory, recordkeeping, and dispensing on behalf of the registrant. The role is officially designated by the registrant on form DOH-4330.

What are examples of controlled substances?

Some examples are morphine, , oxycodone (OxyContin), , methylphenidate (Ritalin), and dextroamphetamine (Dexedrine).

Who can prescribe Adderall in NYS?

The only person who can prescribe Adderall to you is a physician or psychiatrist who is familiar with your symptoms, overall medical history, and treatments attempted in the past. If you feel Adderall may be right for you, schedule an appointment with your doctor and mention your symptoms.

Doh 4330-2026

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