Request a waiver for requirements of 105 CMR 722

In some cases, hospitals can request a waiver from the requirements of 105 CMR 722.080 or 105 CMR 722.090. Submit your request here.

Division of Health Care Facility Licensure and Certification

The Details of Request a waiver for requirements of 105 CMR 722

What you need for Request a waiver for requirements of 105 CMR 722

  • The health care facility’s (hospital) licensed name
  • MA DHCFLC hospital license number
  • Address, including zip code
  • MA Controlled Substance Registration
  • A list of MA Schedule VI controlled substance(s) included in the waiver
  • Information of the facility authorized representative:
    • Name
    • Title
    • Mailing address
    • Phone number
    • Signature
  • Information of the facility clinical representative:
    • Name
    • Title
    • Mailing address
    • Phone number
    • Signature

How to request Request a waiver for requirements of 105 CMR 722

  1. Download and complete the Hospital Request Form for Waiver of Requirements 105 CMR 722 - Dispensing Procedures for Pharmacists (DOC)
    • Note: a separate waiver request form must be submitted for each requirement to be waived.
  2. Mail the completed form to:

    Division of Health Care Facility Licensure and Certification
    99 Chauncy St.
    2nd Floor
    Boston, MA 02111

Contact for Request a waiver for requirements of 105 CMR 722

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