Pharmacy Forms & Instructions

The Board of Pharmacy, together with the Secretary of State’s Office of Professional Regulation (OPR), work to administer licensing for your profession. The documents on this page serve to guide applicants and licensees through initial application or renewal.

Pharmacists

• Pharmacist Application Instructions
• Internship-Hour Requirements for ACPE-Accredited Programs

Pharmacy Technicians

• Pharmacy Technician Application Instructions 

Pharmacy Interns

• Pharmacy Intern Application Instructions
• Pharmacy Internship Hours Reporting Form
• Request for Change in Preceptor and/or Employment
• Verification of Pharmacy Education Form

Out-of-State Registered Pharmacists (Tele-pharmacy)

• Out-of-State Telepharmacist Application Instructions

In-State Pharmacies

• In-State Pharmacy Application Instructions
• In-State Pharmacy Renewal Instructions
• In-State Pharmacy Affirmation
• In-State Pharmacy Change in Manager Form
• Drug Outlet Incident Report

Non-Resident Drug Outlets

• Non-Resident Drug Outlet Application Instructions
• Non-Resident Drug Outlet Renewal Instructions
• Non-Resident Drug Outlets Affirmation Form
• Non-Resident Change in Pharmacist in Charge Application
• Non-Resident Drug Outlet Statement of Pharmacist In Charge Form
• Drug Outlet Incident Report
• Legend Device Policy

In-State Manufacturers

• In-State Manufacturer Application Instructions
• In-State Manufacturer Renewal Instructions

Manufacturers & Wholesalers

• Manufacturer or Wholesaler Application Instructions
• Manufacturer or Wholesaler Renewal Instructions
• Manufacturer or Wholesaler Affirmation
• Manufacturer or Wholesaler Change of Contact Person Application
• Wholesale Drug Outlet Statement of Contact Person Form
• Drug Outlet Incident Report
• Legend Device Policy
• Board Policy on Licensure of Virtual Drug Manufacturers, Contact Manufacturers, Virtual Manufacturers, Brokers/Intermediaries/Facilitators, and Repackagers/Relabelers

Nuclear Pharmacy

• Nuclear Pharmacy Application Instructions
• Affirmation Form

Third Party Logistics

• Third Party Logistics Application Instructions
• Affirmation Form

503B Outsourcer

• 503B Outsourcer Application Instructions
• Affirmation Form

CE

• Course Provider Fee Exemption guidance

For more information, please contact:

Corey Young
802-828-2373
corey.young@vermont.gov