Forms
- BNE Loss of Controlled Substances Report - DOH-2094
- DEA Form 106 (Online)Report of Theft or Loss of Controlled Substances
- DEA Form 41 Record of Controlled Substances Destroyed
- DEA Form 222 Ordering Form
- Reverse Distributor List - Surrender to Independent Companies
- Power of Attorney Form
- Practitioner Failure to Provide Official Prescription
- DMV Vision Screening Test Log
- Pharmacy EPCS Registration Form
- APPLICATION FOR REGISTRATION IN EXPANDED SYRINGE ACCESS PROGRAM (ESAP)
- VAERS Online Reporting Form
- Notice of Change of Supervising Pharmacist
- Notice of Resignation of Supervising Pharmacist
- Name Change Form
- Address Change Form
- DEA Form 224 (online) to Register a Pharmacy
- Checklist for Opening Pharmacy
- RxPAC Contributions (Online Form)
- PSSNY Membership Application (Online Form)
- Application for Limited (Intern) Permit