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:
- This form is supplied to you as part of the syllabus when you attend the APR Designated Rep Training Seminar
- www.pharmacy.ca.gov/forms/desig_rep.pdf
To change the Designated Representative-in-Charge:
- Must be completed within 30 days of any change of DRIC
- www.pharmacy.ca.gov/forms/change_desig_rep.pdf
To change your name or address of record:
- 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
- www.pharmacy.ca.gov/forms/change_of_addrs.pdf
To make changes to wholesaler or non-resident wholesaler permit:
- Includes changes to company name, corporate officers, or business address
- www.pharmacy.ca.gov/forms/change_of_permit_wls.pdf