Out of State Mail Service Pharmacy Amendments

 
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Facilities
 
 
Yes
No

What would you like to do?

What you need to know

There is no charge for the amendment process. Submit the amendment application to the state of Nebraska within 30 days of the effective date of change. If you need to make more than one amendment to the license, you may check all applicable boxes on the same amendment form and submit the required information for each amendment being processed.

If the Nebraska licensed pharmacist leaves employment at the facility, the facility must halt all shipments and deliveries to Nebraska patients until such time that the facility has completed the amendment process.

Mail Service Pharmacy Permit Amendment Application

Submit the following for the type of amendment you wish to make:


Change of Nebraska licensed pharmacist
  • Submit a completed amendment application with the Nebraska licensed pharmacist box checked.

Change of Pharmacist-in-Charge (PiC) (This is not the same designation as the Nebraska licensed pharmacist.  The PIC is the person designated on the facility's home state license.)
  • Submit a completed amendment application with the Pharmacist-in-Charge box checked; and
  • a copy of his/her state pharmacist license from the state in which the facility is located

Change of name of facility or anything that would change the information available on your home state license 
  • Submit a completed amendment application with the location, name, or other box checked; and
  • a copy of the facility's home state license showing that the change being requested has been made to the home state license