**New - Fingerprint Instructions

Credit Card Transmittal Form [PDF]

Termination Form

CONTROLLED SUBSTANCE REGISTRATION FORMS -

~Pharmacist~ Controlled Substance Application

DEA Practitioner Address Change -Use this link to login to the online form provided for reporting your address change to DEA. Once the form is completed print a copy to include with the Controlled Substance registration application or fax to 208/334-2363.

Practitioner Controlled Substance Registration Packet - Use this form if you are NOT a pharmacist and have prescriptive authority from your licensing board. Idaho no longer recognizes locum tenen assignments
All practitioners must hold a valid controlled substance registration prior to prescribing, dispensing, administering or maintaining an inventory of controlled substances in Idaho.

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 using this link.

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

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 apply for reciprocity go to NABP 'License Transfer'

Order a copy of the Law Book from Shop or download it for free!

PHARMACY STUDENT FORMS -

Extern/Intern Application for Registration

Externship Hours Form

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

NAPLEX & MPJE Testing Information

Preceptor Site Application

PHARMACY TECHNICIANS - Update 07/21/2009

Effective July 1, 2009 Idaho requires pharmacy technicians to be certified by ExCPT or PTCB in addition to being registered with the Board of Pharmacy. Technicians registered prior to July 1, 2009 are 'grandfathered' and are not required to be certified as long as they remain with the same employer.

Technicians that are not certified by one of the approved certification boards, may register as a Technician-In-Trainingprovided they are employed in a pharmacy. Technician-In-Training registrations expire one year after issuance and may be renewed one time only. Application forms are available from the pharmacy or the Board office. If you need to request a waiver you may use this waiver form.

All technicians are required to report their work locations, the Employment CHANGE Form should be used to report changes. All 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.

Technicians that are currently registered with the Board (June 30, 2010 expiration date) and are currently certifed by one of the approved certification boards may complete the Certified Pharmacy Technician application form and return with the required documentation to receive their Certified Pharmacy Technician registration from the Board office. (If the current Board of Pharmacy registration has an expiration date of June 30, 2010 there is no fee due at this time.)

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

IDAHO PHARMACY FORMS 

Change in Operation  

Change of Pharmacy Hours 

Differential Hours Request

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

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 

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 09/17/2009

Meeting excerpt~~ During the June 19, 2009 meeting of the Board Mr. Johnston noted that statute 54-1755(1)(b) requires the Board by July 1, 2009 to determine a targeted implementation date for electronic track and trace pedigree technology, which may be no sooner than July 1, 2010 and extended by the Board in one year increments. By unanimous consent the Board agreed to extend by one year, thus not requiring electronic track and trace pedigree prior to July 01, 2011.~

Wholesale Distributor Act & Rules 2009  ~

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

~~~To request a fingerprint packet click here. Print cards must be submitted in accordance with the criteria listed in the Fingerprint Instruction Sheet found here.

Wholesale Distributors and Third Party Logistics companies - Request a fingerprint packet by sending an email.

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

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.