Forms and Instructions

Pharmacist Licenses/Permits
Change of Pharmacist in Charge
Change of Pharmacist in Charge Extension Form 
License by Examination   
License by Reciprocity   
Pharmacist License Reinstatement Form 
Compounding Questionnaire 
Nursing Home Consultant 
Preceptor Application 
Foreign Applicants 
Administer Immunization Certification 

Interns
Intern Application 
Intern Training Plan 
Affidavit of Experience  

Pharmacy Technicians 
2021 Pharmacy Technician Application
2021 Pharmacy Technician Reinstatement

Criminal Background Check Forms
Effective July 28, 2021, in accordance with Act 630, background checks from individuals in Arkansas must be submitted electronically (live scan). Paper fingerprint cards will no longer be accepted and will be returned to the applicant and an electronic submission will be required before
the application on file with the Board can continue to be processed. Out of State applicants will still submit completed fingerprint cards, as the State of Arkansas is not currently set up to receive electronic fingerprint submissions from out-of-state locations.
In-State Criminal Background Check Identity Verification (CBC) Form
Out-of-State Criminal Background Check Identity Verification (CBC) Form

Business Licenses
Retail Pharmacy Application – In State 
Retail Pharmacy Application – Out of State 
Hospital Pharmaceutical Services 
Institutional Pharmaceutical Services 
Wholesale Distributor of Legend Drugs 
Supplier of Medical Equipment, Legend Devices, and Medical Gas (DME license) 
Wholesale Distributor of List I Chemicals 
Charitable Clinic Application 
Pharmacist in Charge Compliance Affidavit 

Other Forms
BEGINNING JANUARY 1, 2018 THE ARKANSAS STATE BOARD OF PHARMACY WILL NO LONGER REVIEW AND APPROVE EDUCATION SESSIONS AS CONTINUING EDUCATION HOURS, THAT ARE NOT CO-SPONSORED/DEVELOPED BY THE ARKANSAS STATE BOARD OF PHARMACY.  IF YOU HAVE QUESTIONS OR CONCERNS ABOUT THIS, CALL THE BOARD AT 501-682-0190.
Change Form (Name, Address, or Employment) 
Closing of Pharmacy Form 
Complaint Form 
Inspection Request Form 
Mailing List Order Form
Wall Certificate Request Order Form
Request for Waiver Form 
Medical Release Form

Other Resources
Overview of Prescribing Authority
Purple Book: Lists of Licensed Biological Products with Reference Product Exclusivity and Biosimilarity or Interchangeability Evaluations
Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations
Samples of protocols, authority to administer immunizations, and sample forms for immunizations/vaccines 
Drug Categories for Emergency Kits in Long-Term Care Facilities
Drug Categories for Emergency Kits in Crisis Stabilization Units
Suggested Procedures When Buying or Selling a Pharmacy 
Effects of New Federal Meth Act on Arkansas Pseudo Law 
Multidose Memorandum of Understanding 
DBHS OBHS Regulation 4 Waiver
Shrink Report Tool | Excel
Suspicious Order Report System (SORS)

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