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How to use or fill out 250 FEE MUST ACCOMPANY THIS APPLICATION - OK
- Click ‘Get Form’ to open it in the editor.
- Begin by entering your Pharmacy License number and the date issued in the designated fields at the top of the form.
- Select the applicable fees for your application type by checking the boxes next to Pharmacy License, Drug Supplier Permit, or Parenteral Permit. Ensure you calculate the total amount due accurately.
- In Section A, clearly print your name and/or doing business as (dba) name along with your address. This information is crucial for processing your application.
- Indicate your type of ownership by checking one of the options provided in Section B. If there has been a change of ownership since your last renewal, answer accordingly in Section C.
- Complete Sections D through H by providing details about your pharmacy type, designated pharmacist-in-charge, and any relevant applicant history questions. Be thorough and honest in your responses.
- Finally, ensure that you sign and date the application where indicated. Remember that this signature must be notarized before submission.
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