Nonresident Pharmacy Permit Application {17A-57}

17A-57, NONRESIDENT PHARMACY LICENSE APPLICATION, This application must be approved by the California State Board of Pharmacy before a nonresident pharmacy license will be issued. The applicant nonresident pharmacy shall not conduct business in California until a license is issued. If changes are made during the application process, the applicant may need to submit a new application with appropriate fees. Any application not completed within 60 days after being notified by the board of deficiencies may be deemed to have been abandoned, and the applicant will be required to file a new application and meet all the requirements that are in effect at the time of application. Fees applied to this instant application are not transferable or refundable. Failure to provide any of the requested information may result in the application being considered incomplete. Any material misrepresentation in the answer of any question is grounds for denial or subsequent revocation of the license and is a violation of the California Penal Code. “The withdrawal of an application for a license after it has been filed with a board in the department shall not, unless the board has consented in writing to such withdrawal, deprive the board of its authority to institute or continue a proceeding against the applicant for the denial of the license upon any ground provided by law or to enter an order denying the license upon any such ground.” (Bus. & Prof. Code § 118, subd. (a).) The information will be used to determine qualifications for licensure under the California Pharmacy Law. www.FormsWorkflow.com