Forms Provided by the California State Board of Pharmacy

Click on the appropriate form to download

To Verify a Designated Rep or Wholesaler License:
www.pharmacy.ca.gov/online/verify_lic.shtml
Click on "Designated Representative", or "Wholesaler" depending on which license you are verifying, then enter the name of the person or business you need to check.

Designated Representative Application:
www.pharmacy.ca.gov/forms/desig_rep.pdf
This form is supplied to you as part of the syllabus when you attend the APR Designated Rep Training Seminar

To change the Designated Representative-in-Charge:
www.pharmacy.ca.gov/forms/change_desig_rep.pdf
Must be completed within 30 days of any change of DRIC

To change your name or address of record:
www.pharmacy.ca.gov/forms/change_of_addrs.pdf
Must be completed within 30 days of change of name or address. This is for your personal designated rep certificate, not a wholesaler business license

To make changes to wholesaler or non-resident wholesaler permit:
www.pharmacy.ca.gov/forms/change_of_permit_wls.pdf
Includes changes to company name, corporate officers, or business address

Designated Representative Training Certification program approved by the California State Board of Pharmacy.
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