Form ph 210 2025

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4.8 out of 5

66 votes

The document is a Pharmacy Information Form (PH210) issued by the New York State Board of Pharmacy, detailing the application process for pharmacy registration. It includes sections for applicants to provide information about ownership, pharmacy operations, physical layout, and compliance with state regulations. The form requires details on the type of registration sought (full store or department), operational specifics, and attestation of compliance with pharmacy laws.

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Click ‘Get Form’ to open it in the editor.
Begin with Part I, where you will check the appropriate box for your registration type: FULL STORE or DEPARTMENT. Ensure you enter the name of the owner or corporation exactly as it appears on your Certificate of Incorporation.
Fill in the Trade Name and Pharmacy Address, including all required details such as city, state, and ZIP code.
Select one option from section 4 regarding your pharmacy's status—New Pharmacy, Transfer of Ownership, Change of Location, or Renovation—and provide the necessary dates and previous registrant information if applicable.
In section 5, describe your pharmacy's daily operations clearly and concisely. This helps convey your business model effectively.
Answer questions about facilities in section 6 by selecting 'Yes' or 'No' for each item listed regarding equipment and storage.
Complete Part II by drawing a scale diagram of your pharmacy layout as specified. Make sure to highlight key areas like drug storage and compounding spaces.
Finally, sign and date the attestation in Part III to affirm that all information is accurate before submitting your completed form to the Board of Pharmacy.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (66 Votes)
2007	4.1 Satisfied (60 Votes)

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