Miscellaneous Changes to a Pharmacy License
All changes to a pharmacy license must be submitted in writing and on the appropriate form. If a form does not exist for the change, the pharmacy may submit a written statement that includes, at minimum, the following:
- Pharmacy Name
- Address of the Pharmacy
- Pharmacy License Number
- Detailed Information of request change.
- If changing Number of Hospital Beds or Pharmacy Type for a Class C license – provide a copy of the DSHS Hospital/Ambulatory Surgical Center License.
TSBP may request additional information to verify the information being changed.
These miscellaneous requests may be sent to firstname.lastname@example.org.