Application For Change Of Pharmacist-In-Charge {17A-14 }

17A-14, APPLICATION FOR CHANGE OF PHARMACIST-IN-CHARGE (PIC), The owner of a pharmacy and the PIC are required by California law to notify the California State Board of Pharmacy in writing within 30 days after the termination or change of the PIC. Failure to make this notification to the Board may result in a citation and fine or other disciplinary action. The proposed PIC shall be approved by the Board. INSTRUCTIONS: Submit a Change of PIC form and $130 Application Fee (California government owned facilities are fee exempt through 6/30/2021). Please make checks payable to the Board of Pharmacy. A Certification of Personnel form, fingerprint cards, and the $49 fingerprint card processing fee is required by the new PIC ONLY if the pharmacist is not licensed in California. If a PIC is currently associated with an active nonresident pharmacy license and has electronic fingerprints on file with the California State Board of Pharmacy, new fingerprints may not be required. www.FormsWorkflow.com