TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF PHARMACY

Forms

Titles of Regulations: 18VAC110-20. Regulations Governing the Practice of Pharmacy.

18VAC110-21. Regulations Governing the Licensure of Pharmacists and Registration of Pharmacy Technicians.

18VAC110-30. Regulations for Practitioners of the Healing Arts to Sell Controlled Substances.

Agency Contact: Erin Barrett, Director of Legislative and Regulatory Affairs, Board of Pharmacy, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 750-3912, or email erin.barrett@dhp.virginia.gov.

FORMS (18VAC110-20)

Application for a Pharmacy Permit (rev. 1/2024)

Application for a Nonresident Pharmacy Registration (rev. 1/2024)

Application for a Nonresident Wholesale Distributor Registration (rev. 4/2024)

Application for Registration as Nonresident Manufacturer (rev. 10/2020)

Application for a Nonresident Third-Party Logistics Provider Registration (rev. 4/2024)

Application for Registration as a Nonresident Warehouser (rev. 10/2020)

Application for a Nonresident Outsourcing Facility Registration (rev. 10/2020)

Application for an Outsourcing Facility Permit (rev. 10/2020)

Application for a Medical Equipment Supplier Permit (rev. 10/2020)

Application for a Permit as a Restricted Manufacturer (rev. 10/2020)

Application for a Permit as a Nonrestricted Manufacturer (rev. 10/2020)

Application for a Wholesale Distributor Permit (rev. 4/2024)

Application for a Permit as a Warehouser (rev. 10/2020)

Application for a Permit as a Third-Party Logistics Provider (rev. 4/2024)

Application for Registration as a Nonresident Medical Equipment Supplier (rev. 10/2020)

Application for a Controlled Substances Registration Certificate (rev. 8/2024)

Closing of a Pharmacy (rev. 9/2025)

Application for Approval of an Innovative (Pilot) Program (rev. 8/2023)

Registration for a Pharmacy to be a Collection Site for Donated Drugs (rev. 5/2018)

Application for Approval of a Repackaging Training Program (rev. 10/2020)

Registration for a Facility to be an Authorized Collector for Drug Disposal (rev. 5/2018)

Application for Reinspection of a Facility (rev. 3/2023)

Notification of Distribution Cessation due to Suspicious Orders (rev. 5/2018)

Staffing Requests or Concerns Form (eff. 9/2023)

FORMS (18VAC110-21)

Application for Licensure as a Pharmacist by Examination (rev. 3/2023)

Application for Licensure as a Pharmacist by Endorsement (rev. 3/2023)

Instructions for Reinstating or Reactivating a Pharmacist License (rev. 3/2023)

Instructions for Reinstating a Pharmacy Technician Registration (rev. 4/2023)

Application for Registration as a Pharmacy Technician (rev. 7/2025)

Application for Registration as a Limited-Use Pharmacy Technician (rev. 7/2025)

Affidavit for Limited-Use Pharmacy Technician (rev. 5/2018)

Application for Registration as a Pharmacy Technician Trainee (rev. 7/2025)

Application for Registration as a Pharmacy Intern (rev. 3/2023)

Application for Registration as a Pharmacy Intern for Graduates of a Foreign College of Pharmacy (rev. 3/2023)

Affidavit of Practical Experience as a Pharmacy Intern (rev. 3/2019)

Name Change Form for Individuals (rev. 3/2018)

Application for Approval of a Continuing Education Program (rev. 10/2020)

Application for Approval of an Innovative (PILOT) Program (rev. 6/2021)

Application for Approval of a Repackaging Training Program (rev. 10/2020)

Continuing Education (CE) Credit Form for Preceptors (rev. 7/2020)

Application for Approval of ACPE Accredited Pharmacy School Courses for Continuing Education Credit (rev. 6/2020)

Sponsor Certification for Volunteer Registration (rev. 4/2018)

Application for Volunteer Practice by a Pharmacist (rev. 4/2018)

Continuing Education (CE) Credit Form for Volunteer Practice (rev. 4/2018)

FORMS (18VAC110-30)

Application for a Controlled Substances Registration Certificate (rev. 10/2020)

Controlled Substances Registration Inspection Report (rev. 1/2020)

Application for a License to Sell Controlled Substances by a Practitioner of the Healing Arts (rev. 3/2023)

Application for Facility Permit for Practitioners of the Healing Arts (rev. 10/2020)

Application for Limited Use Limited-Use Facility Dispensing Permit for Nonprofit (rev. 8/2023)

Application for Limited Use Limited-Use Practitioner Dispensing License for Nonprofit (rev. 8/2023)