Maine > Statewide > Board Of Pharmacy
Mail Order Pharmacy Application - Maine
| Mail Order Pharmacy Application Form. This is a Maine form and can be used in Board Of Pharmacy Statewide . |
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STATE OF MAINE BOARD OF PHARMACY Application and applicant information to assist in completing your application Mail Order Pharmacy READ THIS CAREFULLY Filing an application does not constitute approval to begin to ship drugs into Maine. You must have an active license before you ship to Maine. Please do not submit a partially completed application, including failure to submit all required supporting documents, your application will not be accepted and will be returned. Fees are nonrefundable, including applications that are incomplete. You will be required to submit a new application together with the Fee. Only fully completed applications will be accepted. 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: pharmacy.lic@maine.gov Published under appropriation 01402A4380012 Revised 08/2012 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. Please do not call our office regarding the status of your application as numerous calls will delay the timeliness of processing 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. 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. Once your license is issued it is immediately visible online with an "active" status and you may begin to operate. Please be advised that licenses are printed off site and require at least 14 business days for delivery. 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 `professions and occupations' then scroll to and click on `pharmacy' which will bring you to the Board of Pharmacy web page. Please use the topic selection grouping in the blue panel to the right of your screen. Notwithstanding, please pay particular attention to the following: 32 MRSA c. 117, Subchapter 5 Board Rules, Chapter 11 Published under appropriation 01402A4380012 Revised 08/2012 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 (§7(B)). Disclosure of your Social Security Number Is mandatory. Solicitation of your Social Security Number is solely for tax administration purposes, pursuant to 35 MRS §175 as authorized by the Tax Reform Act of 1975 (42 USC §405(C)(2)(C)(1)). Your Social Security Number will be disclosed to the State Tax Assessor or an authorized agent for use in determining filing obligations and tax liability pursuant to Title 36 of the Maine Revised Statutes. No further use will be made of your Social Security N
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