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Pharm Tech, Intern & Pharmacist Application Information

General Information for Individual Applicants

The Fair Information Practice Act: In compliance with Ind. Code 4-1-6, this agency is notifying you that you must provide the requested information, or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.
Mandatory Disclosure of U.S. Social Security Number: Your social security number is being requested by this state agency in accordance with Ind. Code 4-1-8-1 and 25-1-5- 11(a). Disclosure is mandatory, and this record cannot be processed without it. Failure to disclose your U.S. social security number will result in the denial of your application. Application fees are not refundable.
Abandon Applications: If an applicant does not submit all requirements within one (1) year after the date on which the application is filed, the application for licensure is abandoned without any action of the Board. An application submitted after an abandoned application shall be treated as a new application.
Pharmacy Technician
Submit the following with your online application:
1. Application fee $25.00: Pay by credit or debit card. All application fees are nonrefundable.
2. Criminal background check
3. Positive Response Documentation: If you answer "Yes" to any legal questions on the application, you must also provide an explanation for your positive response which must include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement.
4. Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree.
5. Age Requirement: Indiana law requires a licensed pharmacy technician to be at least 18 years old.
  - If you are not yet 18, then you must have the managing pharmacist at the pharmacy at which you will be employed submit a statement/letter supporting your request to be a licensed pharmacy technician.
6. Diploma: Copy of a high school diploma or GED or transcripts showing you graduated. You must have your high school diploma or GED in order to obtain your technician license.
  - If you do not have a high school diploma or GED you may obtain a technician-in-training permit, provided you only practice in a Board-approved training program (you must submit proof either from the Pharmacy or School on what approved program you will be in - this can be in the form of a letter) and submit documentation that you are actively pursuing a high school diploma or GED.
  - You will need to submit a copy of your high school diploma or GED before you can obtain your technician license.
Obtained by Methods Defined for Additional Requirements: There are three potential obtained by methods with their individual requirements listed below.
- Examination: Copy of your Examination Pass Notice from an Indiana Approved Examinations listed below.
- Training and Education:
  - If you have NOT completed an Indiana board approved training and education program, then you will need to request a Tech-in-Training Permit on the Questions section of the Pharmacy Technician New Application. You will do the following:
    - On the application Question section, choose YES in response to the statement I wish to obtain a Tech-in-Training Permit; and
    - Enter the Name and License Number of the approved Indiana Training Program you will complete.
    - The next section of these instructions will provide further guidance on Tech-In-Training Permit.
- Reciprocity: If the applicant meets the requirements defined in IC 25-1-21-5, an additional requirement item will be an Official Verification of Licensure. Additional requirements may be necessary to determine substantial equivalency at the discretion of the Board.
Pharmacy Technician-in-Training
If you have NOT completed an Indiana board approved training and education program OR have not successfully completed the PTCB or ExCPT examination, then you need to apply for the the Pharmacy Technician and follow the bulleted instructions under Training and Education in the above section to request the Tech-in-Training Permit.
Completed Your Training? Do not submit submit a new application for licensure. Please upload your Affidavit of Completion or Certificate of Completion from a Board approved training and education program to your MyLicense One account using the Action Item from your linked Tech-in-Training Permit called Upload Additional Documentation.
- Affidavit of Completion of a Board Approved Training and Education Program
Need an Extension? If you have an Active Tech-in-Training Permit and need an extension to complete your training, your Pharmacist Supervisor must login to their MyLicense One account and use the Extension Request for Pharmacy Tech-in-Training Action Item. The request needs to be submitted approximately a week before the permit expires so staff has sufficient time to review the request and process it.
Expired Permit? If your technician-in-training permit is expired, your application for the Pharmacy Technician would also be considered abandoned at that time, therefore you will need to reapply with a brand new Pharmacy Technician application, fee etc., and meet all the requirements as if you never applied previously.
Tech-In-Training Permits are NOT renewable.
Pharmacist Intern
Submit the following with your online application:
1. Application fee $10.00: Pay by credit or debit card. All application fees are nonrefundable.
2. Positive Response Documentation: If you answer "Yes" to any legal questions on the application, you must also provide an explanation for your positive response which must include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement.
3. Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree.
4. Certificate of Enrollment or Graduation in Pharmacy Education: Page 3 of this document must be completed and signed by the Secretary or Dean of the School of Pharmacy of which you are currently enrolled or are a graduate.
  - Applicants who are graduates of a pharmacy program outside the United States do NOT need to have this section completed; you are required to submit proof of their Foreign Pharmacist Graduate Examination Committee (FPGEC) Certificate. There are no exceptions to the FPGEC Certificate.
  - Go to Foreign Pharmacy Certification | NABP for more information.
5. Sponsor Affidavit for Pharmacy Intern: Page 4 of this document must be completed as follows and submitted:
  - Applicants who are graduates from a non-accredited program must have an employer or sponsor who is an Indiana licensed pharmacist to check off in the appropriate box and sign the form. Since graduates of non-accredited programs do not have the "Certificate of Enrollment or Graduation" section completed, the "Sponsor Statement and Affidavit" is required to be completed in full and the application cannot be processed without this information.
6. Affidavit of Experience – Pharmacist Intern Training Program Form: Completion of the practical experience requirements of the college of school of pharmacy from which the intern has graduated, if the curriculum of the college or school has been accredited by:
  - The American Council on Pharmaceutical Education (ACPE);
  - The Canadian Council on Pharmacy Accreditation
  - Another board approved practical experience program.
In the event the intern has graduated from a non-accredited program or has no practical experience as a part of their curriculum, the intern must complete a minimum of 1,500 hours of practical experience under the supervision of a pharmacist.
Additional Experience Information
- The period of experience shall be computed and credited from the date the pharmacist intern registration is issued, with no credit given for any experience in pharmacy prior to registration issuance.
- The acceptable pharmacist intern practical experience time must be verified by submitting to the Indiana Board of Pharmacy the Affidavit of Experience which is signed at the termination of each period of practical experience. All affidavits must list all practical experience time on a calendar week basis showing actual time served each week. Acceptable practical experience time per week shall consist of not less than four (4) hours and not more than sixty (60) hours per week.
- Practical experience time served in another state will be accepted if the following requirements are met: (1) the practical experience time serviced in such other state meets all requirements of Indiana law and is experience time of the type that is acceptable to the Indiana Board of Pharmacy and (2) The applicant has a valid intern license from the state where the experience is served. These hours must be verified from the other state to the Indiana Board of Pharmacy.
- Prior approval is required for experience in a site other than a pharmacy. A request must be submitted to the Board prior to beginning the experience period.
Transferring Indiana Intern Hours to Another State
If you are seeking a pharmacist license in another state, and require your Indiana intern hours to be transferred to that state, you must make a request in writing to our office. The written request must include your Indiana pharmacist intern registration number, where to send the hours, and a $10 fee; the fee must be in the form of a check or money order made payable to the "Professional Licensing Agency". The request and fee must be submitted to the Indiana Board of Pharmacy at the following address:
Professional Licensing Agency
Attn: Board of Pharmacy
402 West Washington Street, Room W072
Indianapolis, IN 46204
This request is in addition to any potential verification of licensure necessary of an Indiana license to another state.
Pharmacist
Submit the following with your online application:
1. Application fee $100.00: Pay by credit or debit card. All application fees are nonrefundable.
2. Criminal background check
3. Positive Response Documentation: If you answer "Yes" to any legal questions on the application, you must also provide an explanation for your positive response which must include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement.
4. Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree.
5. Documentation Proving Practical Experience: Practical experience requirements (as listed below)
6. Proof of Graduation*: Original copy of the transcript(s) if education is from a pharmacy program accredited by the Accreditation Council for Pharmacy Education (ACPE) OR a pharmacy program accredited by the Canadian Council on Pharmacy Accreditation (CCPA). If you have graduated from a school of pharmacy located outside the United States or Canada, or from a school accredited by CCPA, submit a certified copy of Foreign Pharmacy Graduate Equivalency Committee (FPGEC) certificate.
  - Go to Foreign Pharmacy Certification | NABP for more information.
  - The FPGEC certificate is required by IC 25-26-13-11. There are no alternatives to this requirement and it cannot be waived.
7. Verification of Licensure: Verification of any registration/license/certification to practice any health-related profession or occupation in another state or territory. You may complete this form and send it to the state(s) where you hold a license to be completed and sent to PLA if they do not have their own form of official verification.
8. Exam Reports: Have passed the NAPLEX and MPJE. No candidates will be granted their Authorization to Test (ATT) until all requirements are met.
*If you have not yet graduated, you may submit your application (except for page 3, Certificate of Completion), fee, and any other required documentation prior to graduating.  You may also go ahead and register for the NAPLEX and MPJE at Examinations | National Association of Boards of Pharmacy. The Certificate of Completion may be forwarded after graduation; once received, your application file can be considered complete and you may be made eligible for the examination.
Practical Experience and/Intern Hour Requirements
ACPE Accredited Program Graduates: Candidates will comply with intern hour requirements by completing the practical experience requirements of the school of pharmacy from which the intern has graduated if the curriculum of the school has been accredited by the ACPE. No additional hours are required to be completed. Out of state graduates of ACPE accredited programs are not required to have their hours transferred or verified to our state.  The Certificate of Completion that is filed with our office by your pharmacy school verifies your hours as required for graduation; no additional hours are required to be completed. (Page 3 of State Form 36028).
CCAP Accredited Program Graduates: Candidates may comply with intern requirements by completing the practical experience requirements of the school of pharmacy from which the intern has graduated if the curriculum of the school has been accredited by the CCAPP. Intern hours earned in Indiana cannot be certified by the Board unless the candidate has a valid intern permit. Hours will not be credited until the intern permit is issued. Candidates wishing to complete their hours in Indiana while awaiting test results should obtain an intern permit.
Non-Accredited Pharmacy Program Graduates: Candidates may comply with intern requirements by submitting proof of 1500 intern experience hours served in a licensed pharmacy setting. If part or all of these hours are to be served in Indiana, you must apply for and receive an intern permit prior to beginning your hours. If you earn hours in another state, you must be properly licensed to earn hours in that state and have that state board of pharmacy transfer hours to Indiana.
Re-Examination
If you have failed one or both of the licensing examinations, you must submit a new application by Re-Examination dependent upon which exam(s) were failed, and complete a new criminal background check after the application is received by the agency (even if one was submitted with a previous application)  in order to take the exam(s) again.
If a candidate fails an examination after two (2) sittings, a personal appearance before the Board is required for consultation and to receive their express permission before sitting for the exam a subsequent time.  If you fall into this category, submit the requested application as explained above and send an email to the Board office at pla4@pla.IN.gov to schedule your personal appearance.
Reciprocity for Pharmacists
If you are a licensed pharmacist in another State and meet the reciprocal requirements as defined in IC 25-1-21-5, submit the following with your online application:
1. Application fee $100.00: Pay by credit or debit card. All application fees are nonrefundable.
2. Criminal background check
3. Positive Response Documentation: If you answer "Yes" to any legal questions on the application, you must also provide an explanation for your positive response which must include the violation, location, date, cause number, and disposition. Submit copies of court documents for each instance to support the statement.
4. Name Change Documentation: Documentation of any legal name change if your name differs from that on any of your documents. Documentation may include a copy of your marriage certificate or divorce decree.
5. Electronic Licensure Transfer: Go to Electronic Licensure Transfer Program (eLTP) | NABP to submit your request for an Electronic Licensure Transfer.
6. MPJE Exam: Register for the MPJE at Examinations | National Association of Boards of Pharmacy. No candidates will be granted their Authorization to Test (ATT) until all requirements are met.
Additional requirements may be necessary to determine substantial equivalency at the discretion of the Board.

Pharmacy Facility Application Information

General Information for Facility Applicants

The Fair Information Practice Act: In compliance with Ind. Code 4-1-6, this agency is notifying you that you must provide the requested information, or your application will not be processed. You have the right to challenge, correct, or explain information maintained by this agency. The information you provide will become public record. Your examination scores and grade transcripts are confidential except in circumstances where their release is required by law, in which case you will be notified.
Abandon Applications: If an applicant does not submit all requirements within one (1) year after the date on which the application is filed, the application for licensure is abandoned without any action of the Board. An application submitted after an abandoned application shall be treated as a new application.
Pharmacy and CSR-Pharmacy
Pharmacy (In-State Pharmacy)
Submit the following with your online application:
1. Application Fee $100: Pay by credit or debit card. All application fees are nonrefundable.
  - Change in Ownership, Remodel, and/or Relocation Application Fee is $50.00.
2. Drawing or Blueprint: To be of your proposed licensed area (clarification on whether your licensed area is just the prescription department or the entire store is required); This drawing or blueprint should show the physical size (include linear dimensions) and general layout of the floor plan; show the location of the prescription counter top with dimensions, location of the refrigerator, and prescription sink.
3. Responsible Pharmacist: Sets forth the name of the Indiana licensed pharmacist who will be in full responsible charge for the legal operation of the pharmacy.
4. USP 795-797 Compliance: If your facility engages, or plan to engage, in compounding, please provide evidence of USP 795/797 compliance (Example: hood inspection reports, policies and procedure regarding sterile and non-sterile compounding, etc.).
5. Classes of Pharmacy Permits: Identify the Class/Category during your application:
  - Category I. A retail permit for a pharmacy that provides pharmaceutical care to the general public by the dispensing of a drug or device.
  - Category II. An institutional permit for hospitals, clinics, health care facilities, sanitariums, nursing homes, or dispensaries that offer pharmaceutical care by dispensing a drug product to an inpatient under a drug order or to an outpatient of the institution under a prescription.
  - Category III. A permit for a pharmacy that provides closed door, central fill, mail order, or other processing operations that are not open to the general public but include:
    - (A) traditional pharmacy functions; or
    - (B) nontraditional pharmacy functions, such as infusion, nuclear pharmacy, or sterile compounding.
6. Positive Response Documentation (if Required): If your answer is “Yes” to any of the legal questions during the application, explain in the text box, including all related details, and upload copies of all relevant arrest or court documents. Describe the event including the location, date and disposition. Falsification of any of the following is grounds for permanent revocation of the license or permit issued pursuant to this application.
7. Completed Inspection: Prior to opening the pharmacy, the permit holder shall submit the premises to a qualifying inspection by an Indiana Board of Pharmacy Compliance Officer. Upon receipt of all requested information, the Board office will contact the individual listed on the application to schedule an inspection. A permit will not be issued until this inspection is successfully completed.
CSR-Pharmacy
Submit the following with your online application:
1. Application Fee $100: Pay by credit or debit card. All application fees are nonrefundable.
  - This fee is required for a New Pharmacy, Change in Ownership, and/or Relocation
  - Remodels do not require the CSR Application Fee
2. Positive Response Documentation (if Required): If your answer is “Yes” to any of the legal questions during the application, explain in the text box, including all related details, and upload copies of all relevant arrest or court documents. Describe the event including the location, date and disposition. Falsification of any of the following is grounds for permanent revocation of the license or permit issued pursuant to this application.
Non-Resident Pharmacy
If you are a pharmacy located outside the state of Indiana and dispensing drugs or devices through the United States Postal Service or by other delivery services to patients in the state of Indiana, then you must be registered as a non-resident pharmacy. You must apply for and obtain a nonresident pharmacy registration prior to shipping into the state of Indiana. The nonresident pharmacy must notify the board within thirty (30) days after any change of office location by submitting an application and all requirements.
Submit the following with your online application:
1. Application Fee $100: Pay by credit or debit card. All application fees are nonrefundable.
2. Sample Label: Upload a copy of the label that will be used on the medication containers. Label must indicate the toll-free number for Indiana patients to call.
3. Home State Board Inspection Report: Upload a copy of the last Board inspection report by your home state board;
4. Official License Verifications: Verification of current license of the pharmacy and all pharmacists listed on the application; this must be official verifications from the state board of pharmacy in your home state;
  - If the facility is licensed in other states, you must submit an official license verification from all other states in which you hold a license. Indiana does accept verifications by email at pla4@pla.in.gov This is for the facility and pharmacist(s) only and does not include pharmacy staff.
5. Digital Pharmacy Accreditation (if applicable): Upload a copy of your accreditation issued by NABP (formerly known as VIPPS^®),
  - A nonresident pharmacy that dispenses more than twenty-five percent (25%) of the pharmacy's total prescription volume as a result of an original prescription order received or solicited through the Internet must be accredited through the National Association of Boards of Pharmacy's (NABP) Digital Pharmacy Accreditation, formerly known as Verified Internet Pharmacy Practice Sites ^® (VIPPS^®) and shall obtain and display a seal* of approval on their internet site and anywhere the pharmacy advertises.
  - For more information regarding Digital Pharmacy Accreditation, visit https://nabp.pharmacy/programs/accreditations/digital-pharmacy/.
6. Pharmacist and Corporate Officers: Must provide location, names, and titles of all principal corporate officers and pharmacist(s).
7. USP 795-797 Compliance: If your facility engages, or plan to engage, in compounding, please provide evidence of USP 795/797 compliance (Example: hood inspection reports, policies and procedure regarding sterile and non-sterile compounding, etc.). Policies and Procedures for compounding procedures and these must be specific to your company - not generic.
8. DEA Permit: Upload a copy of your DEA permit, or explanation if you do not have a DEA Permit.
9. NCPDP Number (if applicable): Please provide your NCPDP number. If this number is pending, please make note of this and forward the information to the Board at pla4@pla.IN.gov immediately upon receipt.
*As part of the rebranding from VIPPS in 2020, NABP has discontinued the VIPPS seal. They will provide Digital Pharmacy Accredited customers with a website HTML embed code which will populate the Digital Pharmacy Accreditation seal on their website.
Adding Remote Location to Existing Pharmacy/Non-Resident Pharmacy
The Board may approve a remote location operated by a hospital with a Category II permit that submits the following IC 25-26-13-17(d). Please note that you cannot use a remote location machine until the inspection has been completed and the license issued.
**This application is currently not available online and must be submitted by mail.**
1. Application - State Form 51720: Please download and complete this application and mail it to the address on the upper right hand corner of the application with the below requirements.
2. Application Fee $50: Pay by check or money order. All application fees are nonrefundable.
  - Change in Ownership, Remodel, and/or Relocation Application Fee is $50.00.
  - If adding a remote location that requires a controlled substance, an additional $100.00 fee is required.
3. Drawing or Blueprint: Provide a drawing or blueprint showing the physical size (include dimensions) and general layout of the current licensed pharmacy area as well as one of the proposed remote location site.
4. Site Map: Provide a map indicating the location of the current licensed pharmacy area as well as the proposed remote location, advising of distance between locations; include physical addresses of both sites.
5. Statement of Explanation: Provide a statement or memorandum providing the Board with a general description of the proposed business plan and explain the need for the remote location.
6. Type of Site: Indicate the type of site the proposed remote location will be. Examples include a distribution site, university clinic, rehabilitation facility, warehouse, nuclear pharmacy, retail, hospital, etc.
7. Responsible Personnel: Provide a list of the names, titles, and license numbers (if applicable) of all personnel that will be responsible for the operations.
8. Detailed Policies and Procedures:
  - If applicable, explanation of automation and information including:
    - auxiliary procedures for down time and
    - prescription files back-up information;
  - Authorized personnel with access at the remote site;
  - Qualifying pharmacist responsibilities, including availability to the site;
  - Handling of legend drugs at the remote site:
    - medication delivery,
    - restocking, and
    - inventory reconciliation.
9. Inventory: Include an inventory listing of all legend drugs to be stored, including form and quantities.
10. USP 797 Compliance: If the site is an IV room, please provide the following:
11. Storage and Security: Provide the following regarding the storage and security of controlled substances:
  - Delivery of drugs from main site to proposed remote location site:
    - personnel responsible;
    - type of vehicle; and
    - containers which provide adequate security to guard against in-transit losses.
  - The type of vault, safe, and secure enclosures or other storage system (e.g., automatic storage and retrieval system);
  - The type of closures on vaults, safes, and secure enclosures; and
  - Controls and procedures to guard against theft and diversion:
    - electronic monitoring (motion, alarm, etc.);
    - human monitoring (guards, police, etc.);
    - cameras;
    - other (lockboxes, cages, gates, safe, etc.).
12. Positive Response Documentation (if Required): If your answer is “Yes” to any of the legal questions during the application, explain in the text box, including all related details, and upload copies of all relevant arrest or court documents. Describe the event including the location, date and disposition. Falsification of any of the following is grounds for permanent revocation of the license or permit issued pursuant to this application.
13. Completed Inspection: Upon approval by the Board, the Board office will contact the named individual listed on the application to schedule an inspection.
After all required application(s), fee(s), and documentation are received in the Board office and reviewed, the Board may require clarification on documentation or additional information by requesting your pharmacy schedule a personal appearance at a regularly scheduled Board meeting.
Wholesale Drug Distributor
Submit the following with your online application:
1. Application Fee $100: Pay by credit or debit card. All application fees are nonrefundable
2. Drug Distributor Accreditation: Verification of Drug Distributor Accreditation (DDA), formerly known as Verified-Accredited Wholesale Distributors^® (VAWD^®) accreditation (copy of VAWD certificate). Go to Drug Distributor Accreditation | National Association of Boards of Pharmacy for the application and instructions.
  - Indiana law requires wholesale drug distributors (WDD) of legend drugs to obtain and maintain accreditation from NABP. If you are required to be licensed as a Wholesale Drug Distributor in Indiana, then you are required to be DDA accredited.
  - If you are physically shipping legend drugs into or within Indiana, you must be licensed and obtain DDA unless you are explicitly excepted out of the licensure requirement by statute; as such, any company that does not take physical possession of the legend drugs or is exempted as referenced below does not need a license in Indiana.
3. Change of Location/Ownership (if applicable): A letter stating that the application is for a change of location or ownership and providing the current license number of the facility. When changing ownership you will be issued a new license number.
4. Positive Response Documentation (if Required): If your answer is “Yes” to any of the legal questions during the application, explain in the text box, including all related details, and upload copies of all relevant arrest or court documents. Describe the event including the location, date and disposition. Falsification of any of the following is grounds for permanent revocation of the license or permit issued pursuant to this application.
Third Party Logistics Provider
Submit the following with your online application:
1. Application Fee $100: Pay by credit or debit card. All application fees are nonrefundable.
2. Accreditation: Go to Drug Distributor Accreditation | National Association of Boards of Pharmacy for more information.
3. Official License Verifications: If licensed in another state, verification of the state from which the out-of-state third party logistics provider engages in third party logistics of legend drugs, if that state licenses third party logistics providers; or verification from the federal Food and Drug Administration (FDA) if you no other state license.
4. Positive Response Documentation (if Required): If your answer is “Yes” to any of the legal questions during the application, explain in the text box, including all related details, and upload copies of all relevant arrest or court documents. Describe the event including the location, date and disposition. Falsification of any of the following is grounds for permanent revocation of the license or permit issued pursuant to this application.
5. Inspection Report: Must be compliant with the following storage practices:
EMERGENCY RULE FOR THIRD PARTY LOGISTICS PROVIDERS (1.22.2019): The Board finalized an emergency rule for Third Party Logistics Providers. https://iar.iga.in.gov/register/20180822-IR-856180362ERA.
Remote Dispensing Facility and CSR-Remote Dispensing Facility
The Board may approve a remote or mobile location for Category I, II, or III permits. Pharmacy practice in a mobile or remote location may include, but is not limited to, telepharmacy, automated dispensing, or delivery of cognitive services.
The Board may also register locations that are not in a hospital, ambulatory outpatient surgical center, or health facility as remote dispensing facilities. A remote dispensing facility is a "facility or an automated dispensing system where prescription drugs are prepared or dispensed without the requirement of the use of an onsite pharmacist and where pharmacist supervision may be provided remotely."
Please note that you may not use a remote location machine until the inspection has been completed and the license has been issued. You cannot open a remote dispensing facility until the inspection has been completed and the license issued.
Submit the following with your online application:
1. Application Fee $50: Pay by credit or debit card. All application fees are nonrefundable.
  - The facility must complete a separate controlled substances registration application if storing or dispending controlled substances.
    - Application Fee $100
2. Supervising Pharmacy: You must include the license number of the supervising pharmacy during the application process.
3. Drawing or Blueprint: Provide a drawing or blueprint showing the physical size (include dimensions) and general layout of the current licensed pharmacy area as well as one of the proposed remote location site.
4. Site Map: Provide a map indicating the location of the current licensed pharmacy area as well as the proposed remote location, advising of distance between locations; include physical addresses of both sites.
5. Statement of Explanation: Provide a statement or memorandum providing the Board with a general description of the proposed business plan and explain the need for the remote location.
6. Type of Site: Indicate the type of site the proposed remote location will be. Examples include a distribution site, university clinic, rehabilitation facility, warehouse, nuclear pharmacy, retail, hospital, etc.
7. Responsible Personnel: Provide a list of the names, titles, and license numbers (if applicable) of all personnel that will be responsible for the operations.
8. Detailed Policies and Procedures:
  - If applicable, explanation of automation and information including:
    - auxiliary procedures for down time and
    - prescription files back-up information;
  - Authorized personnel with access at the remote site;
  - Qualifying pharmacist responsibilities, including availability to the site;
  - Handling of legend drugs at the remote site:
    - medication delivery,
    - restocking, and
    - inventory reconciliation.
9. Inventory: Include an inventory listing of all legend drugs to be stored, including form and quantities.
10. Storage and Security: Provide the following regarding the storage and security of controlled substances:
  - Delivery of drugs from main site to proposed remote location site:
    - personnel responsible;
    - type of vehicle; and
    - containers which provide adequate security to guard against in-transit losses.
  - The type of vault, safe, and secure enclosures or other storage system (e.g., automatic storage and retrieval system);
  - The type of closures on vaults, safes, and secure enclosures; and
  - Controls and procedures to guard against theft and diversion:
    - electronic monitoring (motion, alarm, etc.);
    - human monitoring (guards, police, etc.);
    - cameras;
    - other (lockboxes, cages, gates, safe, etc.).
11. Positive Response Documentation (if Required): If your answer is “Yes” to any of the legal questions during the application, explain in the text box, including all related details, and upload copies of all relevant arrest or court documents. Describe the event including the location, date and disposition. Falsification of any of the following is grounds for permanent revocation of the license or permit issued pursuant to this application.
For more information regarding the requirements for remote dispensing facilities, please review IC 25-26-13.5 as well as the Board's emergency rule regarding remote dispensing facilities, which can be viewed here. This rule becomes effective August 30, 2018.

Non-Practitioner Controlled Substance Registration

Non-Practitioner Controlled Substances Registration (CSR) applications require review by the Indiana Board of Pharmacy at their regularly scheduled monthly meetings. Upon approval by the Board, your facility will be subject to an inspection by a Board of Pharmacy Compliance Officer prior to the CSR being issued to your site.

Submit the following with your online application:

Application Fee $100: Pay by credit or debit card. All application fees are nonrefundable
Pharmacy Manager or Person Responsible for Controlled Substances: In addition to providing the person's information on the application, please upload a curriculum vitae.
Controlled Substances Information: During the application you will be required to identify the Drug Schedules, list procedures to be performed that directly involve controlled substances, types and quantities of drugs to be stored, primary storage information, secondary storage information, information on inventory and procedure on documentation.
Positive Response Documentation (if Required): If your answer is “Yes” to any of the legal questions during the application, explain in the text box, including all related details, and upload copies of all relevant arrest or court documents. Describe the event including the location, date and disposition. Falsification of any of the following is grounds for permanent revocation of the license or permit issued pursuant to this application.
Additional Requirements Defined by Specific Types:

Ambulance Service Providers:

Specific protocols for drug monitoring, drug usage, inventory control, destruction, security storage, and access;
Names, credentials, past training, and copies of current DEA registration of staff;
Application is required to be signed by Medical Director;
Policies and procedures to ensure controlled substances are dispensed in a manner that complies with laws, rules, and regulations;
Must provide training documentation of personnel administering the controlled substances.

Hospitals / Clinics, Wholesale Distributors, and Analytical Labs:

A list of procedures to be performed;
Types and quantities of controlled substances to be stored on site organized by schedule number;
Specific protocols for monitoring drug usage, inventory control, destruction, security, storage, and access.

Surgery Center:

A list of procedures to be performed;
Types and quantities of controlled substances to be stored on site organized by schedule number;
Specific protocols for drug monitoring drug usage, inventory control, destruction, security, storage, and access;
Names, credentials, past training, and copies of current DEA registrations of all medical staff;
A copy of the agreement for pharmacy services, if applicable;
Application is required to be signed by the Medical Director.

Researchers and Teaching Institutions:

A list of procedures to be performed;
Types and quantities of drugs to be stored on site (formulary) organized by Schedule number;
Specific protocols for monitoring drug usage, inventory control, destruction, security, storage, and access;
A one page summary of research objectives, research protocol, and curriculum vitae

Manufacturers:

A list of procedures to be performed;
Types and quantities of drugs to be stored on site (formulary) organized by Schedule number;
Specific protocols for monitoring drug usage, inventory control, destruction, security, storage, and access;
Must describe their products and manufacturing procedures.

Non-Practitioner Owner CSR Applicants:

A list of procedures to be performed
Types and quantities of controlled substances to be stored on site organized by schedule number;
Specific protocols for monitoring drug usage, inventory control, destruction, security, storage, and access;
Names, credentials, past training, and copies of all practitioners employed or contracted to dispense controlled substances
A copy of the contract or employment agreement between the non-practitioner owner and the dispenser
Documentation describing the ownership of the facility
Policies and procedures that ensure controlled substances are dispensed in a manner that complies with laws, rules, and regulations

Humane Societies or Animal Control Facilities: (If you are only requesting sodium pentobarbital, ketamine and ketamine products, and/or a combination product containing tiletimine and zolazepam, please see the section entitled "Limited Permits" below.)

A list of procedures to be performed;
Types and quantities of controlled substances to be stored on site organized by schedule number;
Specific protocols for monitoring drug usage, inventory control, destruction, security, storage, and access;
Must provide written documentation of the training of the personnel administering the controlled substances (copies of training certificates will be sufficient);
The name and license number of the veterinarian associated with the facility (a written statement from the DVM acknowledging the association and a copy of licenses will be sufficient).

Limited Permits ($50 fee):
Any humane society, animal control agency, or governmental entity operating an animal shelter or other animal impounding facility may apply to receive a limited permit only for the purpose of buying, possessing, and using:
1. sodium pentobarbital to euthanize injured, sick, homeless, or unwanted domestic pets and animals;
2. ketamine and ketamine products to anesthetize or immobilize fractious domestic pets and animals; and
3. a combination product containing tiletimine and zolazepam as an agent for the remote chemical capture of domestic pets or animals that otherwise cannot be re strained

Type of facility;
Documentation describing the ownership of the facility;
Specific protocols for monitoring drug usage, inventory control, destruction, security, storage, and access;
Written policies relating to storage, security, and procedures for access, handling, and administration of drugs;
Proof that the employees of the applicant who will handle a controlled substance are sufficiently trained to use and administer the controlled substance (copies of training certificates will be sufficient);
Proof that a licensed Indiana veterinarian holding a valid Indiana controlled substances registration and federal DEA registration has been retained to provide technical advice to the facility (a written statement from the DVM acknowledging the association and a copy of licenses will be sufficient).

Home Medical Equipment Provider
Submit the following with your online application:
1. Application Fee $150: Pay by credit or debit card. All application fees are nonrefundable.
2. Liability Insurance: Proof of product liability and professional liability insurance which is location specific.
3. Official License Verifications: If licensed in another state, official verification of licensure must be sent to Indiana. Indiana accepts verifications by email at pla4@pla.in.gov.
4. Reciprocity Applicants: We are currently issuing licenses to HMEs who hold a license in one of the following states: AL, AZ, CA, CO, FL, IL, KS, KY, LA, MD, MI, MS, NC, OH, OR, PA, SC, TN, TX, UT, and VA.
  - If not from one of the above states, additional requirements for Reciprocity Applicants include:
    - Home State Laws: A copy of their home state's statutes/rules regarding HME services; and,
    - Reciprocal Letter: A letter from their home state stating that they offer reciprocity to Indiana HME providers.
5. Medicare and Medicaid Verification Letters: You will be required to upload verification letters.
6. Accreditation (if applicable): Please go to DMEPOS Pharmacy Accreditation | National Association of Boards of Pharmacy for more information.
7. Positive Response Documentation (if Required): If your answer is “Yes” to any of the legal questions during the application, explain in the text box, including all related details, and upload copies of all relevant arrest or court documents. Describe the event including the location, date and disposition. Falsification of any of the following is grounds for permanent revocation of the license or permit issued pursuant to this application.
8. Completed Inspection: (Not for Non-Resident HMEs) Prior to opening, the permit holder shall submit the premises to a qualifying inspection by an Indiana Board of Pharmacy Compliance Officer. Upon receipt of all requested information, the Board office will contact the individual listed on the application to schedule an inspection. A permit will not be issued until this inspection is successfully completed.
Exceptions - The following entities are not required to obtain an HME license to provide home medical equipment services:
1. A home health agency (as defined in IC 16-27-1-2) that does not sell, lease or rent home medical equipment.
2. A hospital licensed under IC 16-21-2 that:
  - (A) provides home medical equipment services only as an integral part of patient care; and
  - (B) does not provide home medical equipment services through a separate business entity.
3. A manufacturer or wholesale distributor that does not sell, lease or rent home medical equipment directly to a consumer.
4. A practitioner (as defined in IC 25-1-9-2) who does not sell, lease or rent home medical equipment.
5. A veterinarian.
6. A hospice program (as defined in IC 16-25-1.1-4) that does not sell, lease or rent home medical equipment.
7. A health facility licensed under IC 16-28 that does not sell, lease or rent home medical equipment.
8. A provider that:
  - (A) provides home medical equipment services within the scope of the licensed provider's professional practice;
  - (B) is otherwise licensed by the state; and
  - (C) receives annual continuing education that is documented by the provider or the licensing entity.
9. An employee of a licensed HME.
10. A pharmacist or pharmacy; however, they are subject to the requirements of IC 25-26-21 and 856 IAC 1-39.
Security Feature Prescription Pad Provider (Vendors)
All controlled substance prescriptions written by Indiana licensed practitioners, as defined by IC 16-42-19-5, must comply with DEA requirements as well as with 856 IAC 1-34 and IC 16-42-22-6 in order for their prescriptions to be accepted for filling in Indiana licensed pharmacies. Indiana licensed practitioners must use controlled substance prescription blanks (security feature prescription paper) from an approved vendor.
Submit a Sample Prescription with your online application, which must meet the below security features:
- A latent, repetitive "void" pattern screened at five percent (5%) in reflex blue must appear across the entire face of the document when the prescription is photocopied.
- There shall be a custom artificial watermark printed on the back side of the base paper so that it may only be seen at a forty-five (45) degree angle. The watermark shall consist of the words "Indiana Security Prescription", appearing horizontally in a step-and-repeated format in five (5) lines on the back of the document using 12-point Helvetica bold type style.
- An opaque RX symbol must appear in the upper right-hand corner, one-eighth (1/8) of an inch from the top of the pad and five-sixteenths (5/16) of an inch from the right side of the pad. The symbol must:
  - (A) be three-fourths (3/4) inch in size; and
  - (B) disappear if the prescription copy is lightened.
- Six (6) quantity check-off boxes must be printed on the form and the following quantities must appear and the appropriate box be checked off for the prescription to be valid:
  - (A) 1–24.
  - (B) 25–49.
  - (C) 50–74.
  - (D) 75–100.
  - (E) 101–150.
  - (F) 151 and over.
- No advertisements may appear on the front or back of the prescription blank.
- Logos, defined as a symbol utilized by an individual, professional practice, professional association, or hospital, may appear on the prescription blank. The upper left one (1) inch square of the prescription blank is reserved for the purpose of logos. Only logos, as defined by this subdivision, may appear on the prescription blank.
- Only one (1) prescription may be written per prescription blank. The following statement must be printed on the bottom of the pad:
  - "Prescription is void if more than one (1) prescription is written per blank."
- Refill options that can be circled by the prescriber must appear below any logos and above the signature lines on the left side of the prescription blank in the following order:
  - Refill NR 1 2 3 4 5 Void after_____.
- Practitioner name and state issued professional license number must be preprinted, stamped, or manually printed on the prescription.
- All prescription blanks printed under this rule shall be four and one-fourth (4 1/4) inches high and five and one-half (5 1/2) inches wide.
- Two signature lines printed at the bottom of the form:
  - Under the blank line on the left side must be printed the words "Dispense as Written"
  - Under the blank line on the right side must be printed the words "May Substitute"
- The name of any controlled substance may not be preprinted on any prescription forms at any time prior to the prescription being prepared and executed for presentation to the patient or the patient's agent. That includes, but is not limited to, typing prescriptions in anticipation of their need and/or using a rubber stamp or similar means to accomplish the same end. Commercially printed forms containing names of controlled substances are also prohibited.
The Board reserves the right to request additional information and/or documentation as needed to make an informed decision on approval of the applicant as a security feature prescription paper provider in Indiana.
Template of Indiana Security Features for Prescriptions
Currently approved vendors may be found on the Free Search & Verify website under PLA's Online Services from the Left Menu.
Pharmacy Technician Training Program
Submit the following with your online application:
1. Course Syllabus and Course Description(s): Provide a complete syllabus with course descriptions, total number of hours (must include at least 160 hours of experiential training and define how it will be completed.)
2. Instructors: Provide a list of instructors and copies of their resumes.
3. Examination/Testing Details: Provide a copy of any examination and explain the testing process.
Types of Pharmacy Technician Training Programs:
Option 1: Comprehensive curricular-based education and training program conducted by a pharmacy or educational organization.
Option 2: Pharmacy Technician Certification Board (PTCB) exam or another nationally recognized certification exam.
Option 3: Technician training program utilized by the employer that includes specific training in the duties required to assist the pharmacist in the technical functions associated with the practice of pharmacy.
Pharmacy Continuing Education Sponsor
Submit the following with your online application:
1. Agenda: An agenda documenting the hours of organized learning experience;
2. Course Detail and Materials: Any supplementary materials (outlines, hand-outs, bibliographies, copies of slideshow presentations, etc.);
3. Speaker Credentials: A copy of the speaker’s curriculum vitae, description of speaker’s expertise, work history or other documentation regarding the speaker’s expertise on the topic; and
4. Learning Objectives: Three (3) learning objectives for the program.
If you are a previously approved Sponsor, who needs to have additional courses approved, please do not apply for a NEW Sponsor application and instead ensure you have linked your CE Sponsor number on your MyLicense One dashboard and then use the Upload Additional Documentation action item.
Electronic Data Intermediary
An Electronic Data Intermediary (EDI) is an entity that provides the infrastructure that connects a computer system used by a prescribing practitioner with a computer system used by a pharmacy. The EDI facilitates the secure transmission of an electronic prescription order, a refill authorization request, a communication, and other patient care information between a practitioner and a pharmacy.
**This application is currently not available online and must be submitted by mail.**
1. Application - State Form 51723: Please download and complete this application and mail it to the address on the upper right hand corner of the application with the below requirements.
2. Guarantee: Submit a statement regarding how the EDI will guarantee the security of the prescription, the practitioner's identity and privacy, the patient's identity, privacy, and confidentiality; and validate the authorized practitioner's licensure status.
3. History: Provide a detailed history of the EDI's experience in providing EDI services.
4. Infrastructure: Provide a description of the infrastructure that the EDI utilizes.
5. Approval in Other State(s): Provide a list of other state(s) in which the EDI is approved to do business.

Pharmacy Facility Updates

This section will provide instructions for different facility updates a Pharmacy Facility license type may incur. This section is for already Indiana licensed facilities. If you do not yet have the appropriate facility license, please use the Application Instruction above.

Legal Name Change for Facility

If your Pharmacy Facility License type has had a legal name change, please log into your MyLicense One account, ensure your existing Indiana license is linked, and select the Upload Additional Documentation Action Item to upload your legal name change documentation verifying the change. This action will require board staff review. Once the name has been changed, you may log back into your account and print a free facility certificate to meet your posting requirements.
Change of Ownership

If your Pharmacy Facility License type has had a change in ownership, please refer to the above Application Instructions by license type. If the fee amount is not defined in the Application Instructions, you may refer to the Fee Schedule. Each facility with a Controlled Substance Registration must submit a new CSR application after the submission of the Change of Ownership application.
A new license number will be issued.
Change of Location

If your Pharmacy Facility License type has had a change in location, please refer to the above Application Instructions by license type. If the fee amount is not defined in the Application Instructions, you may refer to the Fee Schedule. Each facility with a Controlled Substance Registration must submit a new CSR application after the submission of the Change of Location application.
Prior to opening the pharmacy, the permit holder shall submit the premises to a qualifying inspection by an Indiana Board of Pharmacy Compliance Officer. Upon receipt of all requested information, the Board office will contact the individual listed on the application to schedule an inspection. A permit will not be issued until this inspection is successfully completed.
Remodel

If your Pharmacy Facility License type will be remodeled, please refer to the above Application Instructions by license type. If the fee amount is not defined in the Application Instructions, you may refer to the Fee Schedule. Each facility with a Controlled Substance Registration does not need to submit a new CSR application.
Prior to opening the remodeled pharmacy, the permit holder shall submit the premises to a qualifying inspection by an Indiana Board of Pharmacy Compliance Officer. Upon receipt of all requested information, the Board office will contact the individual listed on the application to schedule an inspection. A permit will not be issued until this inspection is successfully completed.
The license number will not change in this case.
Closure of Facility
Temporary Closure
If a Pharmacy Facility license type will be closed for five (5) consecutive days or more, the permit holder shall notify their Board Compliance Officer and take such steps to secure the drugs in the pharmacy as the Compliance Officer may direct. Please contact pla4@pla.in.gov with details.
Permanent Closure
If a Pharmacy Facility is to be permanently closed for any reason, you shall notify the Board office, not less than twenty (20) days before the transfer of any controlled substances by logging into their MyLicense One account and using the Upload Additional Documentation Action Item. As a part of this Action Item, you must submit the following based on your license type:
- A statement explaining the closure plans for the facility.
- For Pharmacies, you will also submit the following:
  - A Copy of the Inventory Form Required by the DEA with the Name, Address, and Registration Number of the Person to whom the drugs will be transferred.
  - After the request is received, a closure inspection must be scheduled with a Board Compliance Officer.
  - If you have a permanent copy of the Pharmacy Permit, you must return that to the Board within ten (10) days after all drugs and devices are removed from the premises.

Renewal Information

Renewal notices are sent approximately ninety (90) days prior to the expiration date. License holders with valid email addresses on file will be emailed the renewal notice. Those who do not have valid email addresses on file will be mailed the license renewal notice; this notice is mailed to the address of record with the Board. The Board has no way of knowing whether or not a notice reaches its destination; therefore when a notice has been emailed to a valid email address or mailed, the duty of the Board has been performed.

Individual License Type Renewal Information
Pharmacy Technician
Renewal
Pharmacy Technician Licenses expire June 30 of even-numbered years and the renewal fee is $25.00. Pharmacy Technician-in-Training permits (Permit number begins with "99") are valid for one (1) year after the date of issuance. The Technician-in-Training permit is a nonrenewable permit.
Expired Three (3) Years or More
Pharmacy Technician reinstatements have a fee of $50.00 and require the following documentation:
- A valid PTCB or ExCPT certification with your form or
- A statement from your future employer – that they will put you through their approved technician in training program once your license is active; or
- Proof of an active Technician license in another state and proof that you were working in that state as a Technician in the last year.
Pharmacist Intern
Renewal
Pharmacist Intern permits expire September 30 each year, the fee is $10.00, and require one of the following documents:
1. Copy of your Foreign Pharmacy Graduate Examination Committee (FPGEC) Certificate, or
2. A copy of your transcripts from an American Council of Pharmaceutical Education (ACPE) accredited school of pharmacy verifying your active enrollment in the FALL semester or quarter [transcript must indicate the FALL semester or quarter and verify that you are “currently enrolled”, “work in progress”, etc.] or recent graduation date. A transcript indicating that the previous semester or quarter completed will not be accepted as it does not verify that you are currently enrolled.
3. You may also submit a letter from your school that indicated you are currently enrolled in the pharmacy program for the FALL semester or quarter.
Current Pharmacy Students Enrolled in an ACPE Accredited Pharmacy Program:  You are required to submit official transcripts from your ACPE accredited school of pharmacy with your registration renewal application.  The official transcripts must verify your active/current enrollment in the FALL semester or corresponding quarter by indicating "currently enrolled", "work in progress", etc., for your currently enrolled semester or quarter.  A transcript indicating only the previous semester or quarter completed will not be accepted as it does not verify that current enrollment.
ACPE Accredited Pharmacy Program Graduates:  You are required to submit transcripts indicating the date your pharmacy degree was conferred or a copy of your college diploma.
Foreign Pharmacy Graduates:  You are required to submit a copy of your Foreign Pharmacy Graduate Examination Committee (FPGEC) Certificate.
Pharmacist
Active Renewal
Pharmacist licenses expire June 30 of even-numbered years and the renewal fee is $160.00. Pharmacists are required to obtain 30 hours of continuing education prior to renewal.
Inactive Status and Renewals
If you wish to renew your license to Inactive status, you may renew online by selecting "Yes" when asked if you would like to put your license in Inactive status. Maintaining inactive status requires you to continue to renew every 2 years and pay the renewal fee of $160; however you do not need to complete continuing education while in this status.
If your license is on inactive status and you wish to renew to Active status and are filing an online renewal application, you may email your request to change to active status to the Board to pla4@pla.IN.gov; please include your license number with this request and copies of continuing education certificates verifying 30 hours taken in the previous 2 years
Expired Three (3) Years or More
Pharmacists have a reinstatement fee of $260.00 and must include the following documentation:
- Copies of certificates of completion of thirty (30) hours of continuing education within the last 2 years
- If you are licensed in a state other than Indiana, please submit a copy of your current pharmacist license from that state.
- Letter of Work History: Verify in writing where you have been employed and the type of work you have been doing since your license expired.
The Board may require additional information, documentation, or requirements prior to reinstating your license; this would be based on the number of years your license has been expired as well as what type of work you have been doing since it expired.
Facility License Type Renewal Information
Special note for all Facilities: Please ensure that you link your existing record in your MyLicense One account and that you do not use the Initial Application button, unless you are not renewing the existing license for a specific reason and need to apply for a new license.
Pharmacy/NonResident Pharmacy
Pharmacies expire on December 31st of odd-numbered years and the renewal fee is $200.00. Be prepared to provide the following with your renewal:
- DEA number;
- NCPDP number; and
- Facility contact information
Fee Exemptions: If your facility meets the exemption requirements, you can renew online, however, please you must contact our office at pla4@pla.in.gov to request your renewal fee to be waived prior to completing and submitting your renewal online as a payment will be required until you do so. Please include your License Number when you contact our office.  Do not submit any outdated renewal forms via email.
Remote Dispensing Facility
Remote Dispensing Facilities expire on December 31st of odd-numbered years and the renewal fee is  $50.00
Controlled Substance Registration Facility
Controlled Substance Registration (CSR) facilities expire on the same date as their primary facility license and the renewal fee is $100.00. You must submit your primary license renewal prior to submitting your CSR renewal unless you hold a nonpractitioner CSR license.
Wholesale Drug Distributor
Wholesale Drug Distributor licenses expire September 30th of  the even-numbered years and the renewal fee is $100.00. You are required to provide a copy of your Drug Distributor Accreditation (DDA - Formerly VAWD) certificate with your renewal.
Third Party Logistics Provider
Third Party Logistics Provider licenses expire September 30th  of the even-numbered years and the renewal fee is $100.00.  You are required to provide an inspection report, as required by IC 25-26-14-31, dated not more than two (2) years from the date of renewal and issued by:
- The licensing authority in the state where the third-party logistics provider is located; or
- A third-party inspection provider: Any state licensing authority having jurisdiction over the licensure of wholesale drug distributors or third party logistics providers, the federal Food and Drug Administration or the National Association of Boards of Pharmacy's Verified Accredited Wholesale Distributor.
Home Medical Equipment Providers
Home Medical Equipment Provider licenses expire December 31st of the odd-numbered years and the renewal fee is $200.00.
Reinstatements
Any pharmacy facility license expired 3 or more years, pursuant to Indiana Statute, the reinstatement fee will be the above mentioned renewal fee in addition to the application fee (refer to the Fee Schedule below.) All other requirements are listed in the above renewal requirements by license type. The Board may require additional requirements, including, but not limited to, an inspection of the facility as a part of the Board's review and decision of the reinstatement.

Fee Schedule

Individual License Applications/Renewals

Pharmacy Technician Fees
Application	$25.00
Renewal	$25.00
Renewal - Expired up to 3 years	$25.00
Reinstatement - Expired over 3 years	$50.00
Pharmacist Intern
Application	$10.00
Renewal	$10.00
Renewal - Expired up to 3 years	$20.00
Pharmacist Fees
Application	$100.00
Application for Re-Examination - Both Exams	$100.00
Application for Re-Examination - NAPLEX	$100.00
Application for Re-Examination - MPJE	$25.00
Renewal	$160.00
Renewal - Expired up to 3 years	$160.00
Reinstatement - Expired over 3 years	$260.00

Facility License Applications/Renewals

Pharmacy/Nonresident Pharmacy Fees
Initial Application	$100.00
Change of Ownership/Change of Location/Remodel	$50.00
Renewal	$200.00
Reinstatement	$300.00
Remote Location	$50.00
Remote Dispensing Facility
Initial Application	$50.00
Renewal	$50.00
Reinstatement	$100.00
Controlled Substance Registration Facility Fees
Initial Application	$100.00
Limited Application	$50.00
Change of Ownership/Change of Location	$100.00
Renewal	$100.00
Reinstatement	$200.00
Wholesale Drug Distributor Fees/Third Party Logistics Provider Fees
Application	$100.00
Change of Ownership/Change of Location	$100.00
Renewal	$100.00
Reinstatement	$200.00
Home Medical Equipment Provider Fees
Initial Application	$150.00
Change of Ownership/Change of Location	$150.00
Renewal	$200.00
Reinstatement	$350.00

Additional Information

The following is for informational purposes only. This does not and should not be construed as official legal advice or policy from the Indiana Board of Pharmacy. Always review any state or federal regulations that may help answer your question, and if needed seek private counsel. The Board is unable to provide specific legal advice.

Pharmacy Frequently Asked Questions
Does the Indiana Board of Pharmacy require compliance with USP 800?
USP 800 is a standard developed by the United States Pharmacopeia and became effective December 1, 2019. USP is not a regulatory body. This means that the standards they develop are not legal requirements. Their standards only become a legal requirement if the standards are adopted as state or federal law. At this time, the Indiana Board of Pharmacy has not adopted USP 800, and legislation has not been introduced in the Indiana General Assembly either. If either occurs, the Indiana Board of Pharmacy will provide notice to all licensed pharmacies in the state. However, beware that other organizations, such as accrediting bodies, may require USP 800. It is best to consult with your private counsel to determine if any regulating body overseeing your operations requires compliance with USP 800.
What are the required elements of a prescription?
Under Indiana law, all prescriptions must have the following information:
- Name and address of the patient
- Name and strength or size of the drug or device
- Amount to be dispensed
- Adequate directions for the proper use of the drug or device by the patient
- Name of the practitioner
- Issued and signed by a practitioner, either in writing or electronically
See IC 16-42-19-7.
Additionally, all controlled substance prescriptions must also have the following information:
- Dated as of, and signed, the day when issued
- Name, address, and federal controlled substance registration number of the practitioner
See 856 IAC 2-6-4
Can a pharmacy accept a prescription that is printed on plain paper?
Yes, provided all the required elements of a prescription are present.  However, the answer is no if the prescription is for a controlled substance.  All non-electronic prescriptions for a controlled substance must be printed on security paper that has been approved by the Indiana Board of Pharmacy.  A list of current approved security prescription paper providers can be found on the Free Search & Verify Online Service.
Prescriptions utilized by pharmacists to record call-in prescriptions, transferred prescriptions, or facsimile prescriptions do not need to use security prescription paper.
Finally, the name of a controlled substance may not be preprinted on any prescription at any time before the prescription is being prepared and executed.  That includes such activities as typing prescriptions in anticipation of their need, or using a rubber stamp to accomplish the same end.  Commercially printed forms containing names of controlled substances are also prohibited.
See 856 IAC 1-34.
Can our pharmacy fill prescriptions written by physician assistants and nurse practitioners in another state?
Yes.  A pharmacist may fill a prescription written by an out-of-state provider, provided they are licensed in that state, and the pharmacist has taken reasonable steps to determine whether the prescription was issued in compliance with the laws of the state where it originated.
See IC 25-26-13-16
What constitutes a change of ownership of a licensed facility?
Pharmacy permits cannot be transferred between locations or owners.  If there is a change of ownership, an application for change of ownership should be made no later than 10 days after the change in ownership.  The original permit will remain valid until a new permit is issued or the application is rejected.
Whether or not a change of ownership has occurred must be determined by the facility.  The ultimate inquiry is whether there has been a change in who has control over the operations of the facility.  Things to consider include a change in corporate identity, a change in parent organization or a change of legal tax identification number.  A change of officers does not constitute a change of ownership if the corporate structure remains the same.  If in doubt, it best to obtain a new permit.
Electronic Prescribing Frequently Asked Questions
What is an electronic prescription?
The only difference between a regular prescription and an electronic prescription is that an electronic prescription contains the electronic signature of the practitioner and is transmitted in accordance with relevant law.
An e-prescription originates with the prescribing practitioner using a computer, sending the prescription through an approved electronic data intermediary ("EDI"), to a receiving pharmacy's computer. The prescription software used by the prescriber must submit the prescription through an approved EDI in order for the e-prescription to be considered valid.
E-prescribing does not include a prescription that is:
- transmitted by facsimile, including those sent from a prescribing practitioner's computer to a receiving pharmacy's fax machine; or
- printed from the prescriber's computer.
What is an electronic signature?
An electronic sound, symbol, or process attached to or logically associated with an electronically transmitted prescription that is adopted by a person, who intends to sign the electronic prescription.
Can controlled substances be electronically transmitted?
IC 35-48-3-9 was updated to allow electronic prescribing of controlled substances, to follow federal law. In order to electronically prescribe controlled substances, some of the major DEA requirements prescribers must adhere to include:
- Use of an e-prescribing application that is certified for this purpose.
- Completion of a compliant identity-proofing process.
- Use of a secure, two-factor authentication process to sign prescriptions for controlled substances.
A pharmacy cannot process electronic prescriptions for controlled substances until its pharmacy application provider obtains a third party audit or certification review that determines that the application complies with DEA's requirements and the application provider provides the audit/certification report to the pharmacy.
For more information regarding the DEA's requirements for electronically prescribing and/or processing controlled substances, please visit the DEA's website at http://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html.
Is a prescription that is sent via computer to a pharmacy's fax considered an electronic prescription?
No. A faxed prescription has requirements set out in 856 IAC 1-31-1; a faxed prescription must also meet the requirements of IC 16-42-22
Inspection Questions

Pharmacy Inspection Questions
Home Medical Equipment Facility Inspection Questions
CSR Inspection Questions
Remote Dispensing Facility Inspection Questions
DEA Requirements for Electronic Prescribing of Controlled Substances (EPCS)
EPCS requires the individual practitioner be responsible for ensuring the prescription conforms to all legal requirements and the pharmacist, acting under the authority of the DEA-registered pharmacy, has a corresponding responsibility to ensure the prescription is valid and meets all legal requirements.
In order to electronically prescribe controlled substances, some of the major DEA requirements prescribers must adhere to include:
- Use of an e-prescribing application that is certified by a DEA approved entity.
- Completion of a compliant identity-proofing process.
- Use of a secure, two-factor authentication process to sign prescriptions for controlled substances.
A practitioner cannot issue EPCS and a pharmacy cannot process them until its pharmacy application provider obtains a third party audit or certification review that determines that the application complies with DEA's requirements and the application provider provides the audit/certification report to the pharmacy. Review of an EPCS application must be thorough in order to provide the prescriber and pharmacist the level of assurance needed in order to use the application. For more information regarding these third-party reviews, please visit DEA's website at DEA Diversion Control Division | Home.
For more information regarding the DEA's requirements for electronically prescribing and/or processing controlled substances, please visit the DEA's website at DEA Diversion Control Division | Home

Approved Electronic Data Intermediaries

Listed Alphabetically:

Advanced Answers on Demand/AOD Software 11575 Heron Bay Blvd., Suite 200 Coral Springs, FL 33076 Contact: Doc DeVore Phone: 854-718-6422 E-mail: doc@aodsoftware.com Website: AOD Software - Answers On Demand \| LinkedIn Approval Date: 05/11/2015	American Health Tech 574 Highland Colony Parkway Ridgeland, MS 39157 Contact: Maria Arellano MS, RN Phone: 601-572-3147 E-mail address: marellano@healthtech.net Website: www.healthtech.net Approval Date: 6/8/2015	eHealth Solutions, Inc: SigmaCare 575 Eighth Avenue 15th Floor New York, NY 10018 Contact: G. Robert Russell Phone: 212-268-4242 E-mail: rrussell@sigmacare.com Website: Sigma Care Services Approval Date: 01/10/2011
Emdeon Business Services (eRx Network) 100 Lexington Street, Suite 400 Fort Worth, TX 76102-2759 Contact: Dana Venable Phone: 866-379-6389 E-mail: dvenable@emdeon.com Website: http://www.emdeon.com Approval Date: 05/13/2013	FDB Vela 701 Gateway Blvd., Ste 600, South San Francisco, CA 94080 Contact: Jason Reed, PharmD Phone: (513) 594-5003 email: jason.reed@FDBVela.com website: www.fdbvela.com Approval Date: 10/04/2022	Kaleido Health Solutions 2810 N. Church St., Suite 19204 Wilmington, DE 19802 Contact: Dr. Amina Chaudhry Phone: (843) 303-9168 email: achaudhry@kaleido-health.com website: www.Kaleido-health.com Approval Date: 07/13/2020
Matrix 7690 Golden Triangle Drive Eden Prairie, MN 55344 Contact: Yuliya Pruzhanskaya Phone: 952-995-9752 E-mail: yuliya@mdiachieve.com Website: EHR software solutions for home- and long-term care providers Approval Date: 3/11/2013	MedAvant Healthcare Solutions 1854 Shackelford Ct, Ste 200 Norcross, GA 30093 Contact: Debra Roddenberry Phone: 770-806-4815 E-mail: droddenberry@medavanthealth.com Website: http://www.medavanthealth.com/ Approval Date: 04/17/2006	Midwest Veterinary Supply, Inc. 5374 Maly Road Sun Prairie, WI 53590 Contact: Brad Shaw Phone: 877-490-3576 E-mail: brad.shaw@midwestvet.net Website: http://www.midwestvet.net/ Approval Date: 11/14/2011
NewCrop, LLC 1800 Bering Drive #600 Houston TX 77057 Contact: Larry Susnow, M.D. Phone: 707-253-2238 E-mail address: isusnow@newcroprx.com Website: www.newcroprx.com Approval Date: 10/28/2015	NTT DATA Long Term Care Solutions, Inc. 8383 158th Avenue, Suite 100 Redmond, WA 98052 Contact: Dave Brotten Phone: 425-307-2265 E-mail: dave.brotten@nttdata.com Website: http://americas.nttdata.com/ Approval Date: 4/14/2014	Office Ally, LLC uses Surescripts, LLC for an EDI 2800 Crystal Drive Arlington VA 22202 Contact: Chantal Germain Phone: (571) 303-0863 email: chantal.germain@surescripts.com Approval Date: 8/11/2014
Omnicare 8351 W. Rockville Road Indianapolis, IN 46234 Contact: Darold R. Barnes Phone: 800-772-7096 E-mail: darold.barnes@omnicare.com Website: http://www.omnicare.com/ Approval Date: 1/14/2013	OmniviewDr/Omnicare Inc. 900 Omnicare Center 201 East 4th Street Cincinnati OH 45202-4248 Contact: Darold Barnes, R.Ph. Phone: (317) 273-1552 ext 53048 Email address: darold.barnes@omnicare.com Approval Date: 12/10/2012	Optimus EMR Inc. 17802 SkyPark Circle, Suite 105 Irvine, CA 92614 Contact: Craig Griffin Phone: 888-617-2457 x207 E-mail: cgriffin@optimusemr.com Website: http://www.optimusemr.com Approval Date: 4/14/2014
Point Click Care 6975 Creditview Road, Unit 4 Mississauga, Ontario Canada L5N8E9 Contact: Catherine M. Phone: 800-277-5889 E-mail: catherine.m@pointclickcare.us Website: http://www.pointclickcare.com/ Approval Date: 1/14/2013	Precision Pharmacy Management 31089 US HWY 19N Palm Harbor FL 34684 Contact: Peter Bolos Phone: (888)958-0261 Email address: pbolos@synergyrx.com Approval Date: 01/08/2018	PrescribersConnection 2095 Exeter Road, #80-102 Germantown, TN 38138 Contact: Sonya Oetting Phone: 855-793-9773 E-mail: sonya.oetting@prescribersconnection.com Website: http://www.prescribersconnection.com Approval Date: 2/10/2015
Sure Scripts, LLC 5971 Kingstowne Village Pkwy, Ste 200 Alexandria, VA 22315 Contact: Ken Whittemore, JR Phone: 703-921-2114 E-mail: Ken.Whittemore@surescripts.com Website: http://www.surescripts.com/ Approval Date: 04/17/2006	Vetstreet, Inc. 780 Township Line Road Yardley, PA 19067 Contact: Oliver Keane Phone: 240-599-2328 E-mail: okeane@vetstreet.com Website: http://www.vetstreetpro.com/ Approval Date: 04/16/2012	Vision by HealthMEDX 5100 N Towne Centre Dr Ozard, MO 65721 Contact: Dan Cobb Phone: 417-449-3310 E-mail: dan.cobb@healthmedx.com Website: http://www.healthmedx.com Approval Date: 02/08/2010
Weno Exchange LLC 8127 Mesa Drive, B206-201 Austin, Texas 78759 Contact: Kevin Pauley Phone: 877-890-3726 E-mail: Kevin@wenoexchange.com Website: http://www.wenoexchange.com Approval Date: 06/10/2013

Prescription Related Topics

Controlled Substance Prescription Requirements
A prescription for a controlled substance must be issued for a legitimate medical purpose in a reasonable quantity by an individual practitioner acting in the usual course of his professional practice. The responsibility for the proper prescribing is upon the prescribing practitioner.
All prescriptions for controlled substances shall be written with ink, indelible pencil, or typewriter, and shall be issued with the following:
1. dated as of and signed on the day when issued;
2. full name and address of patient;
3. name, address, and DEA registration number of the practitioner;
4. manual signature of prescriber;
5. name, strength, dosage, quantity of the drug being prescribed;
6. directions for use;
7. number of refills (if any);
The prescribing practitioner is responsible for ensuring that the prescription conforms to all requirements of both state and federal regulations.
All controlled substance prescriptions written by Indiana licensed practitioners [as defined by IC 16-42-19-5] must be issued on approved security feature prescription pad paper [856 IAC 1-34] in order for their prescriptions to be accepted for filling in Indiana licensed pharmacies.
The name of any controlled substance may not be preprinted on any prescription forms at any time prior to the prescription being prepared and executed for presentation to the patient or the patient's agent.  That includes, but is not limited to, typing prescriptions in anticipation of their need and/or using a rubber stamp or similar means to accomplish the same end.  Commercially printed forms containing names of controlled substances are also prohibited.
While some states and insurance carriers limit the quantity of controlled substances dispensed to a 30-day supply, there are no specific federal limits to quantities of drugs dispensed via a prescription.  Indiana law does not address quantities, therefore we require you to defer to federal guidelines.
Indiana law requires that a prescription for a schedule II prescription must be filled within one (1) year of being signed.  Schedule III, IV, and V controlled substances shall be filled or refilled no more than six (6) months after the date on which such prescription was issued, and no prescription shall be authorized to be refilled more than five (5) times.
Issuance of Multiple Prescriptions
The refilling of a prescription for a controlled substance listed in schedule II is prohibited.
The DEA has revised its regulations regarding the issuance of multiple prescriptions for schedule II controlled substances. A prescribing practitioner may issue multiple prescriptions authorizing the patient to receive a total of up to a 90-day supply of a schedule II controlled substance provided the following conditions are met:
1. Each separate prescription is issued for a legitimate medical purpose by an individual practitioner acting in the usual course of professional practice;
2. The individual practitioner provides written instructions on each prescription indicating the earliest date on which a pharmacy may fill each prescription;
3. The individual practitioner concludes that providing the patient with multiple prescriptions in this manner does not create an undue risk of diversion or abuse;
4. The issuance of multiple prescriptions is permissible under state laws (Indiana law defers to federal regulations regarding this issue);
5. The individual practitioner complies fully with all other applicable requirements under the CSA and CFR as well as Indiana law.
Authorization for Emergency Dispensing
An emergency situation means those situations that:
1. immediate administration of the controlled substance listed in schedule II is necessary;
2. no appropriate alternative treatment is available; and
3. it is not reasonably possible for the prescriber to provide a written prescription.
In case of an emergency situation, a pharmacist may dispense a controlled substance listed as a schedule II upon receiving oral authorization of a prescribing practitioner, provided the following:
1. the quantity prescribed and dispensed is limited to the amount adequate to treat the patient during the emergency period only;
2. the prescription shall be immediately reduced to writing by the pharmacist;
3. if the prescribing individual practitioner is not known to the pharmacist, s/he must make reasonable effort to determine that the oral authorization came from a registered individual practitioner; and
4. within seven (7) days after authorizing he emergency oral prescription, the prescriber shall cause a written prescription for the emergency quantity prescribed to be delivered to the dispensing pharmacist. The prescription shall have "Authorization for Emergency Dispensing" written on it face and the date of the oral order. The written prescription may be delivered to the pharmacist in person or by mail; if by mail, it must be postmarked within the seven (7) day period. The pharmacist shall notify the Board of Pharmacy if the prescriber fails to deliver the written prescription.
Prescriptions for Weight Reduction
Indiana Code 35-48-3-11 states that only a physician licensed under IC 25-22.5, a physician assistant licensed under IC 25-27.5, or an advanced practice nurse licensed under IC 25-23 with prescriptive authority may treat a patient with a Schedule III or Schedule IV controlled substance for the purpose of weight reduction or to control obesity.
A physician licensed under IC 25-22.5, a physician assistant licensed under IC 25-27.5, or an advanced practice nurse licensed under IC 25-23 with prescriptive authority may not prescribe, dispense, administer, supply, sell, or give any amphetamine, sympathomimetic amine drug, or compound designated as a Schedule III or Schedule IV controlled substance under IC 35-48-2-8 and IC 35-48-2-10 for a patient for purposes of weight reduction or to control obesity, unless the physician, physician assistant, or advanced practice nurse does the following:
1. Determines through review of the physician's records of prior treatment of the patient or the records of prior treatment of the patient provided by a previous treating physician or weight loss program, that the physician's patient has made a reasonable effort to lose weight in a treatment program using a regimen of weight reduction based on caloric restriction, nutritional counseling, behavior modification, and exercise without using controlled substances and that the previous treatment has been ineffective for the physician's patient.
2. Obtains a thorough history and performs a thorough physical examination of the physician's patient before initiating a treatment plan using a Schedule III or Schedule IV controlled substance for purposes of weight reduction or to control obesity.
Theft or Loss of Controlled Substances

Every DEA registrant is required to notify the DEA field office in their area of any theft or significant loss of controlled substances upon its discovery. Every DEA registrant (practitioner, pharmacy, hospital/clinic, manufacturer, distributor, etc.) must comply with this requirement. Please use the link listed below to access the DEA Form 106. This form needs to be submitted online to the DEA.
Report of Lost or Stolen Controlled Substances
Indiana law requires that the registrant notify the Indiana Board of Pharmacy in writing of any theft or significant loss of any controlled substances upon discovery of such theft or loss. Thefts must be reported whether or not the controlled substances are subsequently recovered and/or the responsible parties are identified and action taken against them. You will need to save a copy of the filed DEA Form 106 and submit to the Indiana Board of Pharmacy by to PLACompliance@pla.in.gov and pla4@pla.in.gov.

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