Secondary Type*Please Choose One
The Kiosk or Remote Pharmacy Permit application is intended for existing resident chain,
independent, government, hospital or limited service pharmacies wanting to add a remote or kiosk
pharmacy.
The Kiosk or Remote Pharmacy Permit application should be used for new kiosk, remote
pharmacies, or pharmacies with changes in ownership of more than 30%.
Kiosk or remote pharmacies must:
• Operate under a contract with a pharmacy licensed and located in Arizona, and
• Be supervised by a pharmacist licensed and located in Arizona who is designated as the
pharmacist in charge or supervising pharmacist.
Application Requirements
Applicants must submit:
1. A complete Kiosk or Remote Pharmacy Permit application;
2. A detailed floor plan showing proposed pharmacy area including size and security;
3. A copy of the pharmacy lease agreement (if not applicable, a zoning statement);
4. Disciplinary orders, if applicable;
5. Denial letters, if applicable;
6. $480.00 application fee. Application fees are NONREFUNDABLE. If you submit a paper application, you must pay the application fee by check or money order. If you wish to pay by debit or credit card, you must apply online.
Requirements for Pharmacy Technicians in a Remote Dispensing Site Pharmacy
Pharmacy Technicians who compound or dispense prescription medications in a remote dispensing site must:
1. Complete an additional two hours of continuing education on remote dispensing site pharmacy practices provided by an approved provider. This CE is in addition to the 20 hours of required CE for all pharmacy technicians.
2. Have at least 1,000 hours of experience working as a pharmacy technician in an outpatient pharmacy setting under the direct supervision of a pharmacist.
Resident Pharmacies:
- A detailed floor plan showing proposed pharmacy area including size and security (not applicable for kiosk);
- A copy of the pharmacy lease agreement (if not applicable, a zoning statement)
- A list of officers or partners, if applicable
- A list of similar businesses, if applicable
- Disciplinary orders, if applicable
- Denial letters, if applicable
- Application fee (this fee is nonrefundable)
Non-Resident Pharmacies:
- A copy of the pharmacy’s home state permit
- A copy of the hospital’s current equivalent license or permit.
- A list of officers or partners, if applicable
- A list of similar businesses, if applicable
- Disciplinary orders, if applicable
- Denial letters, if applicable
- Application fee (this fee is nonrefundable)
Hospital :
- A copy of the hospital’s current equivalent license or permit.
- Disciplinary orders, if applicable
- Denial letters, if applicable