Application For Change Of Pharmacist-In-Charge {17A-14 }

17A-14 - APPLICATION FOR CHANGE OF PHARMACIST-IN-CHARGE (PIC). Business and Professions Code (BPC) section 4113(e) states: “Every pharmacy shall notify the board in writing, on a form designed by the board, within 30 days of the date when a pharmacist-in-charge ceases to act as the pharmacist-in-charge, and shall on the same form propose another pharmacist to take over as the pharmacist-in-charge. The proposed replacement pharmacist-in-charge shall be subject to approval by the board. If disapproved, the pharmacy shall propose another replacement within 15 days of the date of disapproval and shall continue to name proposed replacements until a pharmacist-in-charge is approved by the board.” Failure to make this required notification to the board may result in a citation and fine or disciplinary action. INSTRUCTIONS: Submit an Application for Change of PIC form and the $130 application fee. A Certification of Personnel form, fingerprint cards, and the $49 fingerprint card processing fee is required by the proposed new PIC ONLY if the pharmacist is not licensed in California. If a proposed PIC is currently associated with an active nonresident pharmacy license and has electronic fingerprints on file with the California State Board of Pharmacy, new fingerprints may not be required. Make checks payable to the Board of Pharmacy. www.FormsWorkflow.com