Apply to change information on an existing pharmacy

What you need for Apply to change information on an existing pharmacy

For relocation

• You will need to fill out the Application for Relocation of a Pharmacy or Pharmacy Department, found below
  • You need to return previously issued permits with the application
• You need to pay the relocation fee
• You need to submit an official blueprint or certified architectural plans, drawn to scale
  • These must clearly designate both the prescription and patient consultation areas
  • The pharmacy department should be outlined in red
• You need to complete and submit the Compliance Inspection Form, found below
  • This should be completed by a pharmacist within 30 days of submitting the relocation application
• Signed affidavit
  • The pharmacist who will manage the pharmacy or pharmacy department must be sign the affidavit on the application, and have it witnessed by a Notary Public

For changing the manager of the pharmacy or pharmacy department

• You will need to fill out the Application for Change in Manager of a Pharmacy, found below
• A sworn statement confirming there was a complete inventory evaluation of controlled substances in Schedules II, III, IV, and V
  • The evaluation should be filed with the pharmacy’s controlled substance records
  • Both the outgoing and incoming pharmacist Managers of Record must sign this statement
    • If you are unable to get these signatures, consult the application for other options
• The original pharmacy permit
• A payment of the application fee(s), listed below
• Any additional information as determined by the Board
• Signed affidavit
  • The authorized representative of the pharmacy or pharmacy department must be sign the affidavit on the application, and have it witnessed by a Notary Public

For transfer of ownership

• You will need to fill out the Application for Transfer of Ownership of a Pharmacy or Pharmacy Department, found below
• You need to meet all the requirements of 247 CMR 6.03
• If the pharmacist Manager of Record is changing:
  • Attach an official bill of sale or minutes of meeting
  • Include a certified copy of asset transfer
• If the new owner is a corporation:
  • If the corporation is incorporated in the Commonwealth:
    • Attach a copy of the corporation's Articles of Organization, signed and sealed by the Secretary of State
  • If the corporation in incorporated in another state:
    • Attach a copy of the corporation's Foreign Corporation Certificate, signed and sealed by the Secretary of State pursuant to M.G.L. c. 181, § 4
• The name and address of each officer and director of the corporation and the position held
• The d/b/a name of the corporation
• If the corporation is not publicly owned:
  • The total amount and type of stock issued to each stockholder
  • The names and addresses of said stockholder(s)
• The corporation's outstanding permit and Massachusetts controlled substances registration
• A payment of the fee
• You need to complete and submit the Compliance Inspection Form, found below
  • This should be completed by a pharmacist within 30 days of submitting the transfer of ownership application
• Signed affidavit
  • The authorized representative of the pharmacy or pharmacy department must be sign the affidavit on the application, and have it witnessed by a Notary Public