Credit Card Transmittal Form [PDF]

CONTROLLED SUBSTANCE REGISTRATION FORMS - Contact Dustie Reyna 208/334-2356

~Pharmacist~ Controlled Substance Application

Practitioner Name or Address Change - New info! Use this link to login to the online form provided for reporting your name or address change to DEA. Once the form is completed print a copy to include with the Controlled Substance registration application or fax to 208/334-2040.

Practitioner Controlled Substance Registration Packet
Every person who manufactures, distributes, or dispenses any controlled substance within Idaho is required to register. Learn more about this process. All practitioners must hold a valid controlled substance registration prior to prescribing, dispensing, administering or maintaining an inventory of controlled substances in Idaho.

DEA Address Change Form

Practitioner DEA Form 223 Duplicate Certificate Login Screen -

Practitioner DEA Registration Application 224
This is an online form for new applicants (those who do not currently possess a DEA registration or need an additional DEA registration).

Practitioner DEA Diversion Control Program - Online Forms and Applications
There are a number of application forms and reports required by DEA available on this link to their web site.

Idaho Prescription Blank Requirements 

Controlled Substance Inventory Information 

PHARMACIST FORMS

CE Worksheet Use this handy worksheet to track your CE through out the year

Address Change Form 

Employment Change Form 

Foreign Pharmacist Informational memo

Controlled Substance Application for Pharmacist- $60 annually - Pharmacists must hold a valid controlled substance registration prior to practicing pharmacy in Idaho.

Pharmacist Application Packet For graduating pharmacy students or others applying for licensure by exam

NAPLEX & MPJE Testing Information         NAPLEX Eligibility Added 04/22/2008

Reciprocity Information

To begin the process go to NABP you will find the initial application under 'License Transfer'

Law Book order form

PHARMACY STUDENT FORMS -

Extern/Intern Application for Registration- $50 - Externs shall, prior to obtaining practical experience, be enrolled in an accredited college of pharmacy and make application for registration to the Idaho Board of Pharmacy, on forms provided by the Board, along with the appropriate fee.

Externship Hours Form Updated 12/06/2007- An Idaho Board of Pharmacy Employer's Affidavit will be supplied by the Board and will be certified by a pharmacist.....

Pharmacist Application Packet For graduating pharmacy students or others applying for licensure by exam

NAPLEX & MPJE Testing Information

Preceptor Site Application- $25 annually - An approved training site shall be registered by the Board as a place providing practical and professional training deemed applicable for preparing the extern or intern for licensure.

PHARMACY TECHNICIANS -

Technicians are expected to post a copy of their registration at each location they work at and carry the wallet size copy of their registration with them.

If you have questions, contact the Board office by email or by phone @ 208/334-2356.

Clarification of Pharmacy Duties-Clerks/Cashiers vs Technicians Updated 12/03/2007

IDAHO PHARMACY FORMS 

Change in Operation  

Change of Pharmacy Hours Not to be used for Differential Hours - See Change in Operation

Pharmacy Application Packet If your pharmacy is outside of Idaho do not use this form; use Out of State Mail Service Pharmacy Form

~~Ownership Change Packet~~ You must complete both forms and return with the required fee

PIC Responsibility Form 

Procedures for Closing a Pharmacy 

DEA Diversion Control Program - Online Forms and Applications - When applying for the DEA certificate you must leave the Idaho license number and expiration date blank in order to proceed through the application.

OUT OF STATE MAIL SERVICE PHARMACY FORMS ~ For all pharmacies located outside of Idaho

Name and address changes require new application with new documentation, but no fee is required.

Application Packet - Each out-of-state mail service pharmacy shall be licensed by the Board of Pharmacy prior to filling or shipping prescriptions to patients in Idaho. List of documents required and patient communication form included.

REPORTING REQUIREMENTS - All mail service pharmacies must report all schedule II, III, and IV controlled substance prescriptions filled for Idaho patients. Contact Teresa Anderson at 208/334-2356 to begin the reporting process.

NON-PHARMACY DRUG OUTLET - Contact Sharon Treese

Non-Pharmacy Drug Outlet Registration & Items Guide List 

Institutional Drug Outlet Application 

MANUFACTURERS, WHOLESALERS & DISTRIBUTORS OF CONTROLLED & NON CONTROLLED SUBSTANCES Updated 10/24/2008

Wholesale Distributor Act 2007     Rules 2008  

Designated Representative Forms You must submit fingerprints with the Designated Representative forms.

Designated Representative requirements

$100 per license/registration annually

Wholesale Distributors and Third Party Logistics companies - Use this link to request an application packet for licensure.

Wholesalers of OTC products This form is to be used by companies shipping over-the-counter (OTC) products ONLY and must be approved prior to shipping.

The Reverse Distributor’s registration process remains unchanged; they are required to obtain registration as a drug outlet, including obtaining a controlled substance registration, if receiving controlled substances. 

Manufacturers shipping their own product into Idaho are exempt from the licensing requirement. However, they are still required to register to ship product into Idaho and obtain an additional registration if they are shipping controlled substances. Please email Ellen Mitchell with questions.