Forms - Kansas Board of Pharmacy 2025

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The document is a registration application form for non-resident pharmacies seeking to operate in Kansas. It outlines the necessary fees, required documentation, ownership details, and information about the pharmacy and its operations. The application must be completed with accurate information and submitted along with supporting documents, including proof of current pharmacy registration and inspection reports. Additionally, it includes sections for disciplinary history and pharmacist-in-charge certification.
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  1. Click ‘Get Form’ to open the Forms - Kansas Board of Pharmacy in our editor.
  2. Begin by entering your Resident State and attaching the required documents, including your current pharmacy registration and inspection report.
  3. In the Ownership section, indicate whether this is a new application or a change. Fill in the Owner Information, ensuring all fields are completed accurately.
  4. Provide detailed Pharmacy Information, including physical address and contact details. Ensure to attach a list of all state registration numbers held by your facility.
  5. Complete the Authorized Resident Agent Information section, ensuring you include a licensed pharmacist's details as required.
  6. Fill out the Disciplinary Information section truthfully, attaching any necessary documentation if applicable.
  7. Finally, review all entries for accuracy before signing and dating the Owner Certification at the end of the form.

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Demographic and Administrative Forms Form Number (if applicable)Form Description I-9 Employment Eligibility Verification SF-144 Statement of Prior Federal Service * Employee Address Form (for Bureau of Labor Statistics new employees only) W-4 Federal Withholding Form8 more rows
How Do I Get A Pharmacist License In Kansas? Complete the Kansas Licensure Application for Licensure by Examination or Score Transfer Proof of one year of pharmaceutical experience from your School of Pharmacy or State board in the form of at least 1,740 intern hours. Take and pass both the NAPLEX and Kansas state MPJE.
To renew a Kansas Pharmacy Benefits Manager license, you must satisfy or complete the following requirements: Submit an NAIC business entity renewal application through NIPR. At the time you renew, you must pay a renewal fee of $2,500 by credit card or electronic check through NIPR. The renewal fee is nonrefundable.

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