Application Forms
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You will need Adobe Reader (free) to download most of these forms. The applications marked [DOC] will open in your word processor so that you can fill them in using your computer or print them out and fill them in manually |
Because all applications must be signed, we cannot accept applications through the Internet.
The Board approves all new applications. Allow at least two weeks for applications to be processed. Only completed applications received two weeks prior to board meeting will be considered for approval.
Schedule of Board meetings
To request any changes to the information on your license use this form.
Mail all forms to:
New Mexico Board of Pharmacy
5200 Oakland NE, Suite A
Albuquerque, New Mexico 87113
(505) 222-9830
(505) 222-9845 Fax
(800) 565-9102 In-state toll free
sarah.trujillo@state.nm.us
Renewal Dates: Licenses Eligible for Renewal Online
Pharmacist: end of birth month, every other year
Controlled Substance Practitioner: annually according to the first letter of your last name or the first letter of your business name on the following schedule:
| January | M | July | B |
| February | S | August | C & E |
| March | L & P | September | F & G |
| April | Q & R | October | H & N |
| May | U, V, W, X, Y, Z | November | I & T |
| June | A & D | December | J, K & O |
Renewal Dates: Licenses That Cannot Be Renewed Online
EMS: December 31, annually
Pharmacist clinician: end of birth month, every other year
Pharmacy: December 31, every other year
Pharmacy Intern: September 30, annually
Technician:
end of birth month, every other year
Contact Lens Distributor: Renew on issued month, every other year
Wholesaler: December 31, every other year
Clinic: December 31, every other year
Custodial Homes: December 31, every other year
Controlled Substance Facility : annually according to the first letter of your last name or the first letter of your business name on the following schedule:
| January | M | July | B |
| February | S | August | C & E |
| March | L & P | September | F & G |
| April | Q & R | October | H & N |
| May | U, V, W, X, Y, Z | November | I & T |
| June | A & D | December | J, K & O |
Procedures for Applicants
Download the applications you need for renewing your license from the following list.
All new in-state facilities need a Request for Inspection form except nursing home and custodial care facilities.
A Facility Controlled Substance Application is needed if controlled substances are stored at the facility. Also, A Drug Enforcement Administration Controlled Substance Registration is required.
Applications
- Animal Control Clinic Application, as defined in regulation part 10.10. For the procedure for initial licensure, click here .
- Boarding and Residential Care Home Application. This is for any facility which provides care and services on a continuing basis for two or more in-house residents not related to the operator, and which maintains custody of the residents' drugs. This facility is explained in regulation part 11.9.
- Boarding and Residential Care Home Renewal Application
- Changes Use this form to report changes to the information on your license. Changes include a name change, change in home address, or a change in employment information. You may mail or fax this form or e-mail the changes directly to sarah.trujillo@state.nm.us.
- Custodial Procedures Manual and Pharmacist Agreement For Boarding and Residential Care Homes. This manual does not supply the forms. The forms we supply are the receipt logs, the returned/destroyed logs, and a Pharmacist's Record of Visits log. You may download and print your own forms or contact our office and we will mail them to you.
- Emergency Medical Services Clinic Application as defined in regulation part 24. For the procedure for initial licensure, click here.
- Emergency Medical Services Renewal Application
- Facility Controlled Substance Registration Application For all facilities except for Methadone Clinics and facilities licensed as Analytical Labs, Teaching Institutes, or Controlled Substance Researchers.
- Facility Controlled Substance Renewal Application
- Home Care Service Application as defined in regulation part 19. For the procedure for initial licensure, click here .
- Home Care Service Renewal Application
- Hospital Pharmacy Application as defined in regulation part 7. For procedures on initial licensure, click here .
- Hospital Pharmacy Self Assessment Form
- Intermediate Care Facility or Skilled Nursing Facility Drug Permit Application as defined in regulation part 11. Any facility, skilled nursing facility, intermediate care, or any other upper level of care facility as defined by Health and Human Services Department is required to maintain custody of patients' drugs in a drug room, and such drugs are administered by the facilities' designated personnel. For procedures for initial licensure, click here.
- Intermediate Care Facility or Skilled Nursing Facility Drug Permit Renewal Application
- Limited Controlled Substance Registration Application Use this application if you are an Analytical Lab, a Teaching Institute, or a Controlled Substance Researcher.
- Limited Drug Permit Clinic Application for clinics that are defined as a Public Health Clinic in regulation part 10.11. These clinics are licensed as A, B1, B2, B3, or C. For procedure for initial licensure, click here .
- Limited Drug Permit Clinic RENEWAL Application
- Limited Drug Permit Clinic Self Assessment Form
- Limited Drug Research Application as defined in regulation part 17.
- Limited Retail and Wholesale Veterinary Drug Permit For facilities that sell dangerous drugs limited to veterinary use as defined in regulation part 15.
- Limited Retail and Wholesale Veterinary Drug Permit Renewal application
- Narcotic Treatment Program Facility Controlled Substance Registration Application This is for Methadone Clinics.
- Nonresident Pharmacy Application as defined in regulation part 6.24. A Nonresident Pharmacy is a pharmacy located outside New Mexico that ships, mails, or delivers in any manner prescription drugs to New Mexico patients or consumers. A policy and procedure manual is required with the initial application. For the requirements of a nonresident policy and procedures manual click here.
- Nonresident Pharmacy Renewal Application
- Pharmacist Clinician Application as defined in regulation part 4.1. You will also need the Patient Contact log and instructions:
1) Patient Contact Log Instructions
2) Patient Contact Log - Pharmacist Clinician Renewal Application
- Pharmacy Application [DOC] as defined in regulation part 6, Procedure for Initial In-State Pharmacy Licensing.
- Pharmacy Renewal Application
- Retail Pharmacy Self Assessment Form
- Sterile Product Pharmacy Self Assessment Form
- Pharmacy Intern Registration as defined in regulation part 5. The Intern Packet is six different forms:
1) Location to get approved name tag
2) Intern evaluation of preceptor form
3) Form to report hours earned
4) Form to report change of work or living address
5) Preceptor evaluation of intern form
6) Preceptor application form
- Pharmacist New Application as defined in regulation part 4.
- Pharmacist Renewal Application [DOC] or renew online
- Pharmacist Affidavit must be completed with initial pharmacist registration.
- Pharmacist Temporary Licensure Application
- Practitioner's Controlled Substance Registration Application for individuals who are allowed to prescribe controlled substances. This license is required before the DEA will issue a federal controlled substance license.
- Practitioner’s Manual
- Practitioner's Controlled Substance Renewal Application
- Preceptor Application as defined in regulation part 5, for pharmacists supervising pharmacy interns.
- Remodel or Relocation Application There is no fee for this, but you will also need a Request for Inspection.
- Request for Inspection
- Seller or Dispenser of Contact Lenses Application
- Seller or Dispenser of Contact Lenses Renewal application
- Technician Application [DOC] as defined in regulation part 22. Technicians must complete the Technician Training Record form below.
- Technician Training Record Form required to be in every pharmacy where a technician works. Defined in regulation part 22.
- Technician Renewal Application
- Technician Certification Requirement Extension Request
- Wholesale Drug Distributor Application defined in regulation part 8 and 9. For companies distributing drugs within New Mexico.
- Wholesale Renewal Application
- DEA Controlled Substance Registration Applications
