Montana Pharmacy Board MAIL ORDER PHARMACY REVISED 10/17 Page 1 of 15 MONTANA BOARD OF PHARMACY (301 S PARK, 4TH FLOOR, HELENA, MT 59601 – Delivery) P.O. Box 200513 Helena, Montana 59620-0513 TELEPHONE (406) 841-2300 FAX (406) 841-2344 EMAIL: WEBSITE: APPLICATION FOR: OUT-OF-STATE POSTAL SERVICE ILLEGIBLE AND INCOMPLETE APPLICATIONS WILL BE RETURNED. (Please allow 30 days for processing from the date the Board receives a complete current application.) BUSINESSES MAY NOT OPERATE IN MONTANA IN ANY MANNER WITHOUT ACTIVE REGISTRATION REQUIREMENTS IN MONTANA (24.174.1001-1009 ARM) Out-of-State Postal Pharmacies: No out-of-state pharmacy may ship, ship, or deliver prescription drugs and/or equipment to a patient in that state unless it is registered with the Montana Pharmacy Board. Legal entity registered and in good standing with the Secretary of State of Montana information available at Registered and in good standing with the National Association of Boards of Pharmacy Verified Internet Pharmacy Practice Sites (VIPPS) if registered after June 1, 2001. Keep records of legendary medications and/or devices dispensed to Montana patients in an easily retrievable form. Provide upon request all necessary information to the Montana Board of Pharmacy to fulfill Board222`s responsibilities under laws and regulations for out-of-state postal pharmacies. Maintain pharmacy hours that allow for the timely dispensing of medications to Montana patients and allow Montana patients reasonable access to a licensed pharmacist through these patients.222 Provide a toll-free telephone consultation between a Montana patient and a pharmacy pharmacist who has access to patient records222 and ensure that these telephone numbers are affixed to the label attached to each stamp container. Toll-free telephone service must be available at least 6 days a week and 40 hours a week. In addition, a toll-free number will be made available to the Committee so that all requests for information from the Committee can be met. Identify a pharmacist responsible for dispensing prescriptions for shipment to Montana (not authorized in Montana). Any pharmacy offering home infusion therapies for Montana must be licensed by both the Pharmacy Board and the Department of Public Health and Human Services (DPHHS). For licensing information to DPHH, call or call (406) 444-1575.

FEE: $240 (non-refundable) – Application fee $75 (non-refundable) – Montana Dangerous Drugs Act Distributor Fee **Make a check or money order to the Montana Board of Pharmacy** DOCUMENTS: The following documents must be submitted to the Commission office to complete your licence application. Please make 8 copies 275224 x 11224 of the following information and submit them with your application. Attach a copy of your current DEA registration when applying for dangerous drug donor registration. Copy of the last State inspection. Copy of a technician`s usage plan. Proof of approval with DPHHS Montana when home infusion therapy services are offered. American LegalNet, Inc. Montana Board of Pharmacy MAIL ORDER PHARMACY REVISED 10/17 Page 2 of 15 Proof of registration with the Secretary of State of Montana. Go to 223Business Services224, then 223Forms224, then 223Business Forms224, click Property or Operation Type 223Foreign224 (since this company is a non-Montana State), and then click 223Certificate of Authority224. ADDITIONAL FORMS THAT MUST BE SUBMITTED FOR AN APPLICATION TO BE COMPLETED: National Practitioner Data Bank (NPDB) Self-Disclosure. You can obtain this form by calling or visiting NPDB at 800-767-6732.

This form should be sent directly to the address indicated in the instructions. The results will come to you; upon receipt, please send it in the original sealed envelope to the office of the Board of Directors. Go to 223Run an automatic query224 and 223Run an automatic query for an organization224. Verification of the approval in good condition in the state in which the company is located. Verification of the honourable authorization of the registered pharmacist. If the pharmacy offers home infusion therapies for Montana, it must be licensed by both the Pharmacy Board and the Department of Public Health and Human Services (DPHHS). For information on DPHHS licences, call or call (406) 444-1575. APPLICATION PROCEDURE: If the application documents are complete, they will be processed and reviewed by Executive Board employees for permanent registration.

The applicant may be notified if additional information is required or if he or she is required to appear before the Commission for an interview. If the application is considered a non-routine application, there may be delays in processing the application. You may be asked to provide additional information or to appear in person before the Board at a regular meeting of Council and/or the application may need to be considered by the Board. Non-routine requests can take up to 120 days to process. The license exam must be sent directly to the state agency where the business is located where the chief pharmacist is employed. Please contact the State Council before submitting the application, as some states may charge an audit fee. Notify the Commission office at any time of changes of address, change in licence status, complaints or proposed disciplinary action. This is essential for the timely processing of applications and subsequent licensing. PROCESSING PROCEDURE: Once a routine application is completed, it takes up to 30 days to process the application from the time it is received by the Board office. Missing or missing information in the application file will be communicated to the applicant in writing. Once a current application has been processed and approved, a permanent registration is issued. ADDITIONAL LAWS AND REGULATORY INFORMATION: Senior Pharmacist Identification (PIC) Be reputable licensed in the state where the postal pharmacy is located (the ICP does not need to be licensed in the state of Montana).

Be duly registered on the application form prescribed by the Commission. Comply with all applicable Montana laws and regulations. Immediately notify the Montana Board of Directors of any relevant job or address changes, etc. Immediately notify the Montana Board of Directors of any disciplinary action taken and/or taken against the Apotheker222s license. REGISTERED AGENT: Under ARM 24.174.1002 registration requirements, any out-of-state postal pharmacy must be a legal entity registered with the Secretary of State of Montana and in good standing, with a Montana registered agent for service of the process. The certificate of authority identifying the business entity and its registered representative must be submitted as part of the application. Go to Business Services and then Business Forms to request the Certificate of Authority. American LegalNet, Inc. Montana Board of Pharmacy REVISED MAIL ORDER PHARMACY 10/17 Page 3 of 15 PHARMACY TECHNICIANS: An application for registration of an out-of-state pharmacy of an establishment located in a state that does not regulate the use of pharmacy technicians must not permit a pharmacist to supervise more than one assistive person at the same time in the composition or dispensing of prescription drugs. unless approved by the Council. Any application for registration of an out-of-state pharmacy for postal services from an establishment in a state governing the employment of pharmacy technicians must include information on the ratio of supervisors to authorized technicians in the receiving State and must provide a usage plan for the employment of pharmacy technicians.