Application Requirements & Forms

In State Manufacturers, Repackers, Wholesalers

Application Requirements and Forms

Application Requirements

Under New York State Law, the State Board of Pharmacy registers pharmacy, wholesaler, repacker and manufacturer establishments in New York State. New York is the home state for these establishments that are physically located in this state. For current registrant totals see License Statistics.

An initial application must be submitted for each instate establishment in order to do business in New York. A completed application must be submitted with the required registration fee (see Checklist  MW109 (47 KB) for information on all forms required). Make checks payable to the New York State Education Department. Note: Your cancelled check is your receipt.

You must answer all questions and provide all information requested unless otherwise indicated. Failure to complete all required parts of the application will delay its review. Submit applications directly to the Office of the Professions at the mailing address at the end of the form.

The burden of submitting a properly completed application rests with the applicant. We have provided detailed instructions to assist you. Please read them carefully.

If you are not sure about what is required, especially as it relates to corporate documents and filings, you may wish to consult with your attorney. You should also know that applications are processed in the order in which they are received. In the interest of fairness, we cannot deviate from this policy. Please submit your completed application at least 8 to 12 weeks before the planned opening or transfer of your pharmacy or establishment.

Applicants are urged to retain copies of all applications and documents submitted to the Pharmacy Board Office. Other agencies may require copies of applications for their registration. It is the applicant's responsibility to make and retain these copies. INCOMPLETE APPLICATIONS WILL BE RETURNED TO YOU FOR COMPLETION.

Application Forms

Note: All forms are in Adobe Portable Document Format (PDF). To view or print these documents, you will need to have the free Adobe Reader installed on your computer. Download times and print quality will depend on your connection speed and printer.

• Resident In State Initial Registration or Transfer of Ownership of Manufacturer, Repacker and/or Wholesaler of Drugs, Prescription or Medical Gases
  • Information and Instructions
  • Checklist of Documents Needed MW109 (47 KB)
  • Application MW100  (39 KB)
  • M/W Information Form MW111 (9 KB)
  • Supervisor's Responsibilities
  • Supervisor Application MW104 (28 KB)
  • References
    • Education Law, Section 6808 Registering and operating establishments
    • Regulations of the Commissioner of Education, Section 63.6 Registration and Operation of a New York establishment
    • Code of Federal Regulations, Title 21, Section 205 Guideline for State Licensing of Wholesale Prescription Drug Distributors
• Resident In State Manufacturer/Wholesaler/Repacker Change of Supervisor, Location, Name, Officers and/or Owners

  Registered establishments must notify the NYS Board of Pharmacy whenever there is a change of location, change of name or change of officers and/or owners. See Instructions below for information on filing and fee requirements. In each instance, the appropriate documents and fee, if required, must be submitted to the Office of the Professions at the mailing address at the end of the form whenever these changes occur.

  • Resident In State Manufacturer/Wholesaler/Repacker Change of Supervisor
    • Supervisor's Responsibilities
    • Supervisor Application MW104/Change of Supervisor in Charge MW105 (47 KB no fee)
  • Resident In State Manufacturer/Wholesaler/Repacker Change of Location
    • Instructions
    • Application MW102 (28 KB fee required)
    • M/W Information Form MW111 (43 KB)
  • Resident In State Manufacturer/Wholesaler/Repacker Change of Name
    • Instructions: The preliminary endorsement application (MW102) for change in corporate name should be completed and returned to this office, as soon as possible, with the following:
      1. Copy of Amended Certificate of Incorporation indicating change of corporate name.
      2. Copy of the Filing receipt from Secretary of State for name change.
      3. Wording of any outdoor sign you propose using for this establishment.
      4. Copy of proposed labels (pharmacy, manufacture and repackers).
      There is no charge for a name change.
    • Application MW102 (39 KB no fee)
  • Resident In State Manufacturer/Wholesaler/Repacker Change of Officers and/or Owners
    • Notification Form PB327 (27 KB no fee)