Pharmacy Applications and Forms

Pharmacy: Procedures for Applicants

Download the applications you need for renewing your license from the following list.

 

All new in-state facilities need a Request for Inspection form except nursing home and custodial care facilities.

 

A Facility Controlled Substance Application is needed if controlled substances are stored at the facility. Also, A Drug Enforcement Administration Controlled Substance Registration is required.

Fees submitted are nonrefundable.  16.19.12.8  FEES:  All fees shall be paid in advance of the issuance of any license, permit, certificate or replacement of a certificate and shall not be refundable.

 

The NMBOP will accept check or money orders only.  Credit or debit cards may be used ONLY if renewing online.

Online Renewal:

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MyLicense e-Government
    1. An expired license cannot be renewed online.  Please mail in the renewal application.
    2. Use Internet Explorer 11 or greater (other browsers are not compatible with the licensing database).
    3. Your registration code never changes.
    4. If you have issues logging in to renew, register again to change your username and password.
    5. Additional instructions are available via the following link:  Renewal Instructions
    6. NOTICE:  Your License will NOT update the same day the payment is made. Please be aware that it may take anywhere from 2 to 5 business days for your license to update after payment has been made online.
    7. Receipt:  Please note that your receipt will be emailed to you at the email address you specify at login, please make sure that it’s an email that you can easily access.
    8. Facility licenses, other than controlled substance registrations, are not eligible for on-line renewal.

Initial Application Forms (Scroll Down For Renewal Forms)


Animal Control Clinic Application, as defined in regulation part 10.10. For the procedure for initial licensure, click here.

Boarding and Residential Care Home Application. This is for any facility which provides care and services on a continuing basis for two or more in-house residents not related to the operator, and which maintains custody of the residents’ drugs. This facility is explained in regulation part 11.9.

Changes. Use this form to report changes to the information on your license. Changes include a name change, change in home address, or a change in employment information.

Custodial Procedures Manual and Pharmacist Agreement for Boarding and Residential Care Homes. This manual does not supply the forms. The forms we supply are the receipt logs, the returned/destroyed logs, and a Pharmacist’s Record of Visits log. You may download and print your own forms or contact our office and we will mail them to you.

DEA Controlled Substance Registration Applications  this is a link to the DEA website for DEA controlled substance registration applications.

Designated Representative as defined in regulation part 8.  Use this form to apply for a change in designated representative of a wholesale drug distributor, third-party logistics provider, or repackager.

Drug Warehouse Application means an off-site physical storage location of an in-state clinic, hospital or pharmacy currently licensed by the New Mexico Board of Pharmacy.   Dangerous drugs may be stored for the use of the licensed clinic, hospital or pharmacy.

Emergency Medical Services Clinic Application  as defined in regulation part 24. For the procedure for initial licensure, click here.

Facility Controlled Substance Registration Application. For all facilities except for Methadone Clinics and facilities licensed as Analytical Labs, Teaching Institutes, or Controlled Substance Researchers.

Home Care Service Application as defined in regulation part 19. For the procedure for initial licensure, click here.

Hospital Pharmacy Application as defined in regulation part 7. For procedures on initial licensure, click here.

Intermediate Care Facility or Skilled Nursing Facility Drug Permit Application as defined in regulation part 11. Any facility, skilled nursing facility, intermediate care, or any other upper level of care facility as defined by Health and Human Services Department is required to maintain custody of patients’ drugs in a drug room, and such drugs are administered by the facilities’ designated personnel. For procedures for initial licensure, click here.

Limited Controlled Substance Registration Application. Use this application if you are an Analytical Lab, a Teaching Institute, or a Controlled Substance Researcher.

Limited Dangerous Drug Research Application.  For facilities that will do research with Dangerous Drugs.

Limited Drug Permit Clinic Application for clinics that are defined as a Public Health Clinic in regulation part 10.11. These clinics are licensed as A, B1, B2, B3, or C. For procedure for initial licensure, click here.

Limited Retail and Wholesale Veterinary Drug Permit. For facilities that sell dangerous drugs limited to veterinary use as defined in regulation part 15.

Nonresident facility change of address/business name Use this form to report facility address or name change.  This form cannot be used if there is a change of ownership, or for a change of physical location for facilities that compound sterile preparation/product delivered into NM (new application required).

Nonresident Pharmacy:  as defined in regulation part 6.24. A Nonresident Pharmacy is a pharmacy located outside New Mexico that ships, mails, or delivers in any manner prescription drugs to New Mexico patients or consumers. A policy and procedure manual is required with the initial application. For the requirements of a nonresident policy and procedures manual please review regulation part 6.24, linked above.

    Outsourcing Facility Application as defined in regulation 16.19.37.  An outsourcing facility may or may not be located within New Mexico.  A facility that is currently registered with the Food and Drug Administration (FDA) as an outsourcing facility under Section 503B of the Federal Food, Drug, and Cosmetic Act, and that meets the requirements of that agency to engage in the compounding and distribution of sterile drugs.

    Pharmacist Clinician as defined in regulation part 4.17. You will need the Patient Contact log and instructions:

    Pharmacy Application as defined in regulation part 6, Procedure for Initial In-State Pharmacy Licensing.

    Pharmacy Intern Registration as defined in regulation part 5. The Intern Packet is six different forms:

    Pharmacist Affidavit must be completed with initial pharmacist registration.

    Pharmacist Temporary Licensure Application.  IF YOU ARE A MILITARY SERVICE MEMBER, THE SPOUSE OF A MILITARY SERVICE MEMBER, OR A RECENT VETERAN TRANSFERRING YOUR PHARMACIST LICENSE FROM ANOTHER STATE PLEASE CONTACT ROCIO CRUZ 505.222.9833.

    Pharmacist New Temporary Emergency License Application (sponsoring pharmacy) – license by endorsement for a pharmacist to work in a sponsoring pharmacy in New Mexico, as defined in regulation part 31.8

    Pharmacist New Temporary Emergency License Application – license by endorsement for a pharmacist licensed in a state in which a federal disaster has been declared, as defined in regulation part 31.9

    Practitioner’s Controlled Substance Registration Application for individuals who are allowed to prescribe controlled substances. This license is required before the DEA will issue a federal controlled substance license.

    Practitioner’s Controlled Substance Emergency Registration by Endorsement for practitioners currently possessing a temporary license issued by a NM regulatory agency, as defined in regulation part 31.10

    Preceptor Application as defined in regulation part 5, for pharmacists supervising pharmacy interns.

    Remodel or Relocation Application There is no fee for this, but you will also need a Request for Inspection.

    School Based Emergency Medicine (SBEM) Class D Clinic Application.  The initial application contains a one-time $30.00 Request-For-Inspection fee.  You do not pay this fee if you are renewing your registration.  For your convenience, you may use the NMBOP approved SBEM Class D clinic Policy and Procedure manual.  Also, you may obtain the SBEM Class D Clinic Annual Self-Assessment form.
                   Albuterol MDI Perpetual Inventory Form
                   Epinephrine Auto-Injector Perpetual Inventory Form
                   Drug Storage Area Temperature Log
                   Quarterly Inspection & Out of Temperature Range Log

    Technician Application as defined in regulation part 22. Technicians must complete the Technician Training Record form below.

    Technician Training Record Form required to be in every pharmacy where a technician works. Defined in regulation part 22.

    Wholesale Drug Distributor Application defined in regulation part 8;  and 9. For companies distributing drugs within New Mexico.

    Renewal Forms


    Reciprocity Forms

    NAPLEX, MPJE, and FPGEC Information


    Pharmacy Technicians


    Forms


    Lists


    Manuals


    Protocols


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