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 
2020 Pharmacy Technician Application
2020 Pharmacy Technician Reinstatement

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
Criminal Background Check Identity Verification Form 
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.
CE Approval Request Form | PDF  * See Notice Above*
CE Approval Request Form | Word  * See Notice Above*
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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