CONSULTANT

CONTROLLED SUBSTANCE WAIVER 2013-2014  
DEA

LIST OF ACCEPTABLE DOCUMENTS
NUCLEAR PHARMACY AND PHARMACIST CERTIFICATE APPLICATION
PHARMACIST, INTERN/EXTERN, PRECEPTOR, TECHNICIAN - DO NOT MAIL CASH!
PHARMACY, MANUFACTURER/WHOLESALE/DISTRIBUTION, INSTITUTION, ETC.
PHARMACY LOG BOOKS
PRESCRIPTIVE AUTHORITY
RETAIL MEDICAL OXYGEN

UPDATE OR ADD EMAIL ADDRESS

 

The Pharmaceutical Providers Tax Pamphlet - Alabama Department of Revenue

 

 


APPLICATION or FORM

CONSULTANT
Consultant Application Printable PDF File PDF   (FAX TO 205-981-2330 OR MAIL)

 

DEA
SAMPLE  Alabama Scheduled Listed Chemical Products Logbook Printable PDF File PDF
DEA Form 106 -  Report of Lost or Stolen Controlled Substances   ONLINE ONLINE
Pharmacists Manual Printable PDF File PDF
SAMPLE  Employee Self-Certification Training Form  Printable PDF File PDF  (Training Required by September 30, 2006)
DEA Training Materials for Retailers Printable PDF File PDF
DEA Training Materials for Mobile Retailers Printable PDF File PDF
ARTICLE 9. PRECURSOR CHEMICALS §20-1-190. - Sale of Pseudoephedrine  Printable PDF File PDF    Attn: Wholesalers  Printable PDF File PDF
DEA TIP LINE - 24-hour, toll free "pill mill" tip line is:  888-954-4662  OR  Email to: Florida.Pill.Mill.Tips@USDOJ.GOV

 

PHARMACIST, INTERN/EXTERN, PRECEPTOR, TECHNICIAN
Controlled Substance Waiver 2013-2014 Printable PDF File PDF
Duplicate License/Registration Request   Printable PDF File PDF 
Change of Supervising Pharmacist Printable PDF File PDF 
Change of Name Notification  Printable PDF File PDF  NOTE: NO FEE FOR CHANGE OF NAME FOR AN INTERN/EXTERN.

PHARMACISTS

BLANK - PHARMACIST REGISTRATION RENEWAL 2013-2014  Printable PDF File PDF       Pharmacist Employment Statement  Printable PDF File PDF
PHARMACISTS Change of Status Request - (Address & Employment) ONLINE
Pharmacist Licensure Exam Application   Printable PDF File PDF     (THIS IS NOT THE APPLICATION FOR RECIPROCATING PHARMACISTS)
 
Intern / Extern Application    Printable PDF File PDF  
Practical Training / Internship Report  ONLINE ONLINE  
Preceptor Application Printable PDF File PDF
Pharmacy Internship Training Agreement (TO BE COMPLETED BY NON-LICENSED PHARMACIES) Printable PDF File PDF

TECHNICIANS
TECHNICIANS Change of Status Request - (Address & Employment)   ONLINE
BLANK - TECHNICIAN REGISTRATION RENEWAL 2014-2015 Printable PDF File PDF   and Technician Employment Statement  Printable PDF File PDF  DO NOT MAIL CASH!
NEW TECHNICIANS 2014-2015 Application Printable PDF File PDF   DO NOT MAIL CASH! - - - - - - - NEW TECHNICIANS PLEASE ATTACH A COPY OF DRIVER'S LICENSE
                                                                                                                                AND BIRTH CERTIFICATE

 

MANUFACTURER/WHOLESALE/DISTRIBUTION, PHARMACY, INSTITUTION, ETC.
Closing A Pharmacy in Alabama  Printable PDF File  PDF
Non-Pharmacist Key Holder Designation Form Printable PDF File PDF
Controlled Substance Waiver - 2013/2014 Printable PDF File PDF
Duplicate License/Registration Request   Printable PDF File PDF 
Permit Change of Status Report - Hours of Operation
ONLINE ONLINE

MANUFACTURERS, WHOLESALERS, DISTRIBUTORS
NEW Manufacturers, Wholesalers, Distribution Registration Printable PDF File  PDF Must be printed on legal size paper. 
Please also complete a Manufacturers, Wholesalers, Distribution Verification Form
Printable PDF File PDF

If requesting a change of address, name change or ownership notification print RENEWAL APPLICATION Printable PDF File PDF  
Manufacturers, Wholesalers, Distributor Renewal Statement Printable PDF File

NON-RESIDENT PHARMACIES

NEW Non-Resident Pharmacy Registration Application    Printable PDF FilePDF  Please also complete a Non-Resident Pharmacy Verification Form Printable PDF File PDF
If requesting a change of address, name change or ownership notification print 
BLANK Non-Resident Renewal Application  Printable PDF File PDF  
Non-Resident Renewal Statement Printable PDF File PDF
Inspection Report for 797 Sterile Compounding   Printable PDF File  PDF   
Non-Resident Pharmacies that compound Sterile products will need to complete and file this report along with their application.
Inspection Report for 795 Non-Sterile Compounding   Printable PDF File  PDF   
Non-Resident Pharmacies that compound Non-Sterile products will need to complete and file this report along with their application.

ALABAMA PHARMACIES AND OTHER (PHARMACY SERVICES, PRECURSORS, INSTITUTIONAL)
Pharmacy Registration Application (In-State Only)  Printable PDF File  PDF   Must be printed on legal size paper.
BLANK - PHARMACY REGISTRATION RENEWAL 2013-2014 Printable PDF File PDF  FOR IN-STATE PHARMACIES ONLY!
Pharmacy Renewal Statement Printable PDF File PDF
New Pharmacy Services Permit  Printable PDF File  PDF
Precursor Chemical Application  Printable PDF File PDF  If requesting a change of address, name change or ownership notification print Printable PDF File PDF
Institutional Pharmacy Application - Printable PDF File PDF  Must be printed on legal size paper.   
If requesting a change of address, name change or ownership notification print Printable PDF File PDF

 

NUCLEAR PHARMACY AND NUCLEAR PHARMACY AND PHARMACIST CERTIFICATE APPLICATION
NUCLEAR PHARMACY AND PHARMACIST CERTIFICATE APPLICATION  Printable PDF File PDF

 

RETAIL MEDICAL OXYGEN
Retail Medical Oxygen Renewal Statement Printable PDF File
Retail Medical Oxygen Supplier Permit Application  Printable PDF File PDF    Must be printed on legal size paper.
If requesting a change of address, name change or ownership notification Printable PDF File PDF  

 

PHARMACY LOG BOOKS
Inventory of Controlled Substances Book Printable PDF File PDF
SAMPLE  Alabama Scheduled Listed Chemical Products Logbook Printable PDF File PDF

 

PRESCRIPTIVE AUTHORITY
Prescriptive Authority of Health Professionals    Printable PDF File PDF
H1N1 - What You Need to Know   Printable PDF File PDF  (Flu Shot)       Printable PDF File PDF (Nasal Spray)

Printable PDF File - Adobe Acrobat Required.  NOTE:  Some applications are legal size and require 8 1/2 x 14 paper when using Printable form.


REVISED OCTOBER 2014