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MAINE BOARD OF PHARMACY Application information to assist in completing your application. This information is not designed to include all information on laws and rules and it is strongly recommended that you review applicable laws and rules. Mail Order Pharmacy (Pharmacies NOT located in Maine) Do not return the informational pages with your application; it is for your information only Department of Professional and Financial Regulation Office of Professional and Occupational Regulation (Mailing address) 35 State House Station, Augusta, ME 04333 (Office location) Gardiner Annex, 76 Northern Avenue, Gardiner, Maine 04345 Office Direct Line (207) 624-8620 or Main Receptionist (207) 624-8603 TTY users call Maine relay 711 FAX (207) 624-8637 Web address: www.maine.gov/professionallicensing Email: firstname.lastname@example.org Published under appropriation 01402A4350012 Revised 04/2014 35 State House Station, Augusta ME 04333 Website: www.maine.gov/professionallicensing American LegalNet, Inc. www.FormsWorkFlow.com INFORMATIONAL Receipt of your application does not constitute entitlement to begin to ship into Maine. While applications are logged in as `pending' this does not mean a license has been issued. You must hold an active license in order to begin shipping into Maine. Processing time depends greatly on the completeness of your application. Your application has greater chance of being processed expeditiously if it is complete and all supporting documents are attached. Action on this application is posted to the web in real time. Please visit our website if you wish to monitor progress. If the status appears as Pending, this means that your application was received by this office and it is pending or under review. Once reviewed and if everything about your application is complete and complies with requirements, the license will be issued and the status will show as ACTIVE. If incomplete and a letter is being sent to you, the letter will be available for you to see online. Please refrain from calling our office to "check" on your application as these calls only serve to slow our ability to review and process applications. Information regarding the status of applications may be found at the Office of Professional and Occupational Regulation's website www.maine.gov/professionallicensing. We appreciate your thoughtful attention to this request. Once your license is issued it is immediately visible online with an "active" status. Licenses are printed off site and require at least 14 business days for delivery. there is an urgent need to contact us, please be advised that we will only discuss your If application with the contact person named in the application to avoid miscommunications. This is done not only for your protection, but to also avoid any complications with too many hands involved, which generally leads to miscommunication or misunderstandings. Our goal is to streamline your process, not complicate it. Incomplete applications or documents that have been modified or altered in any way, including use of a white out substance, will not be accepted and will be returned. Pursuant to 32 MRS § 13752 (2)(C) the pharmacist in charge that is "the" named pharmacist in charge for a mail order pharmacy must be the same pharmacist in charge named for the Mail Order Pharmacy license in the state that the pharmacy is physically located. LAW AND BOARD RULE REFERENCE Information contained in this application is not a substitute for carefully reviewing applicable laws and rules. You may obtain a copy of the laws and board rules online at www.maine.gov/ professionallicensing--Click on "list of licensed professionals", click on "Pharmacy" under "Board of Pharmacy Home" click on "Laws & Rules" Notwithstanding, please pay particular attention to the following: 32 MRSA Chapter 117, Subchapter 5 Board Rules, Chapter 11 Published under appropriation 01402A4350012 Revised 04/2014 35 State House Station, Augusta ME 04333 Website: www.maine.gov/professionallicensing American LegalNet, Inc. www.FormsWorkFlow.com STATE OF MAINE DEPARTMENT OF PROFESSIONAL & FINANCIAL REGULATION OFFICE OF PROFESSIONAL AND OCCUPATIONAL REGULATION Mailing Address: 35 State House Station, Augusta, Maine 04333 Courier/Delivery address: 76 Northern Avenue, Gardiner, Maine 04345 Phone: (207) 624-8603 Fax: (207) 624-8637 TTY users call Maine relay 711 web: www.maine.gov/professionallicensing Frequently Asked Questions: Where do I send my application? Our mailing address is 35 State House Station, Augusta, Maine 04333-0035 Where are you located? 76 Northern Avenue, Gardiner, Maine. What hours are you open? 8:00 AM to 5:00 PM weekdays Can I come to Gardiner to drop off my application? Yes. You will not leave with a license, though. Can I come to Gardiner to pick up my license? No. Your license will be mailed to you. How long does it take to process an application? You can check our website: www.maine.gov/professionallicensing. Your license will show up as PENDING at first; as soon as your status is ACTIVE you are authorized to practice. How far back do I go answering the criminal question? Any conviction, ever. NOTICES BACKGROUND CHECK: Pursuant to 5 MRS §5301 - 5303, the State of Maine is granted the authority to take into consideration an applicant's criminal history record. The Office of Professional and Occupational Regulation requires a criminal history records check as part of the application process for all applicants. PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRS §401 et seq). Public records must be made available to any person upon request. This application for licensure is a public record and information supplied as part of the application (other than social security number and credit card information) is public information. Other licensing records to which this information may later be transferred will also be considered public records. Names, license numbers and mailing addresses listed on or submitted as part of this application will be available to the public and may be posted on our website. SOCIAL SECURITY NUMBER: The following statement is made pursuant to the Privacy Act of 1974. Disclosure of your Social Security Number is mandatory. Solicitation of your Social Security Number is solely for tax administration purposes, pursuant to 36 MRS §175 as authorized by the Tax Reform Act of 1975 (42 USC §405(c)(2)(C)(i)). Your Social Security Number will be disclos