Alabama Board of Pharmacy

Forms, Apps and Publications

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PHARMACY TECHNICIANS – E-mail: tlawrence@albop.com
New Application 
E-mail tlawrence@albop.com to reinstate a pharmacy technician registration
Duplicate Registration or Change of Name Form  

PHARMACISTS – E-mail: lmartin@albop.com
New Application 
E-mail lmartin@albop.com to reinstate a pharmacist’s license
Duplicate License/Registration Request  
College Affidavit  
Controlled Substance Waiver  

INTERNS – E-mail: lmartin@albop.com
New Application 
Practical Training / Internship Report  
Pharmacy Internship Training Agreement (TO BE COMPLETED BY NON-LICENSED PHARMACIES)  
Duplicate License/Registration Request  

CERTIFICATIONS - E-mail: lmartin@albop.com
Preceptor Application  
Consultant Application 
Nuclear Pharmacy and Pharmacist Certification Application  

IN-STATE PHARMACIES - E-mail: tking@albop.com
New Pharmacy Application 
New Institutional Pharmacy Application 
Reinstatement/Change of Ownership Pharmacy Application  
Institutional Reinstatement/Change of Ownership Application 
Pharmacy Change of Name or Address Form  
Change of Supervising Pharmacist  
Burglary Procedures 
Closing A Pharmacy in Alabama  
Non-Pharmacist Key Holder Form  
Revocation of Non-Pharmacist Key Holder Form  
Duplicate License/Registration Request  
Controlled Substance Waiver  
Inventory of Controlled Substances Book  

NON-RESIDENT PHARMACIES - E-mail: tking@albop.com
New Non-Resident Pharmacy Application   .
797 Sterile Compounding Questionnaire  
795 Non-Sterile Compounding Questionnaire  
Change of Name or Address Form  
Reinstatement/Change of Ownership Form 
Duplicate License/Registration Request  
Controlled Substance Waiver  
Change of Supervising Pharmacist  

PHARMACY SERVICES – E-mail: tking@albop.com
New Pharmacy Services In-State Application (Must appear before the Board before license can be granted)    .
New Pharmacy Services Out-of-State Application  
Reinstatement/Change of Ownership Application  
Change of Name or Address Form  
Duplicate License/Registration Request  

PRECURSOR – E-mail: kpickett@albop.com
New Precursor Application   .
Duplicate License Request Form  
For reinstatement, E-mail KPickett@albop.com

OXYGEN – E-mail: tking@albop.com
New Retail Medical Oxygen Application (email to tking@albop.com)   .
Retail Medical Oxygen Reinstatement/Change of Ownership, Name or Address Application email to tking@albop.com   .
New Oxygen Application (Manufacturer/Wholesaler) email to kpickett@albop.com   .
Duplicate License Request Form  

FACILITIES – E-mail: kpickett@albop.com
Definitions of Facilities   .
New Manufacturer Application   .
New Wholesale Distributor Application   .
New Private Label Distributor Application   .
New Third-Party Logistics Application  .
New Re-packager Application   .
Individual History Affidavit (must complete for all new facility applications)   .
Business History Affidavit (must complete for all new facility applications)  .
Application Contact Form (must complete for all new facility applications)  .
Payment form (must complete for all new facility applications)   .
Controlled Substance Waiver  
Change of Designated Representative Form   .
Facility Change of Ownership Form   .
Facilities Name and Address Change   .
Duplicate License Request Form  
For reinstatement, E-mail KPickett@albop.com

CONSUMER SERVICES – E-mail: pwright@albop.com
Complaint Form  
Copy of in-state inspections E-mail pwright@albop.com

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