Pharmacy Applications and Forms

Licenses issued by the New Mexico Board of Pharmacy may now be applied for and renewed online through the licensing portal. If you are a first time user, please see the Online License Renewal page for further instructions. Note that you may renew your license beginning 75 days before the license expiration date (90 days for facility licenses).

Pharmacy: Procedures for New Applicants

All license applications are now available through the online licensing portal, including initial licenses. If you are applying for a new license, for yourself or a facility, please use our licensing portal.

If you would like to review our archival license application forms, as an aid to preparing for the online application process, they can be found below. Information and documentation used to complete these forms should then be input into your online license application.

All new in-state facilities need a Request for Inspection form except nursing home and custodial care facilities.

A Facility Controlled Substance Application is needed if controlled substances are stored at the facility. Also, A Drug Enforcement Administration Controlled Substance Registration is required.

Properly executed Facility license applications must be presented before the Board of Pharmacy for approval. Once processed, you may expect your Facility license to be issued sometime after the next Regular Board Meeting.

Fees submitted are nonrefundable. 16.19.12.8  FEES: All fees shall be paid in advance of the issuance of any license, permit, certificate, or replacement of a certificate and shall not be refundable.

Initial Application Forms

(For review only. Applications should be submitted through the online license portal.)

Animal Control Clinic Application, as defined in regulation part 10.10.

Boarding and Residential Care Home Application. This is for any facility which provides care and services on a continuing basis for two or more in-house residents not related to the operator, and which maintains custody of the residents’ drugs. This facility is explained in regulation part 11.

Changes. Use the online licensing portal to report changes to the information on your license. Changes include a change in home address or a change in employment information.

Changes (Name Change Only) Use the linked form to report a change to the name on your license. Submit form with legal document indicating the change.

Contact Lens Policy and Procedure. Contact lens sellers or dispensers may utilize their own policy and procedure manual that addresses all requirements of 16.19.28.9 NMAC, or may use the board-provided manual linked here.

Custodial Procedures Manual and Pharmacist Agreement for boarding and residential care homes. This manual does not supply the forms. The forms we supply are the receipt logs, the returned/destroyed logs, and a Pharmacist’s Record of Visits log. You may download and print your own forms or contact our office and we will mail them to you.

DEA Controlled Substance Registration Applications  this is a link to the DEA website for DEA controlled substance registration applications.

Designated Representative as defined in regulation part 8. Use this form to apply for a change in designated representative of a wholesale drug distributor or third-party logistics provider.

Drug Warehouse Application means an off-site physical storage location of an in-state clinic, hospital or pharmacy currently licensed by the New Mexico Board of Pharmacy. Dangerous drugs may be stored for the use of the licensed clinic, hospital, or pharmacy.

Emergency Medical Services Clinic Application as defined in regulation part 24.

Facility Controlled Substance Registration Application. For all facilities except for Methadone Clinics and facilities licensed as Analytical Labs, Teaching Institutes, or Controlled Substance Researchers.

Home Care Service Application as defined in regulation part 19.

Hospital Pharmacy Application as defined in regulation part 7.

Intermediate Care Facility or Skilled Nursing Facility Drug Permit Application as defined in regulation part 11. Any facility, skilled nursing facility, intermediate care, or any other upper level of care facility as defined by Health and Human Services Department is required to maintain custody of patients’ drugs in a drug room, and such drugs are administered by the facilities’ designated personnel.

LAW ENFORCEMENT DRUG TAKE BACK APPLICATION.

Limited Controlled Substance Registration Application. Use this application if you are an Analytical Lab, a Teaching Institute, or a Controlled Substance Researcher.

Limited Dangerous Drug Research Application. For facilities that will do research with dangerous drugs.

Limited Drug Permit Clinic Application for clinics that are defined as a public health clinic in regulation part 10.11. These clinics are licensed as A, B1, B2, B3, C, or E.

Limited Retail and Wholesale Veterinary Drug Permit. For facilities that sell dangerous drugs limited to veterinary use as defined in regulation part 15.

Medical Gas Repackager or Seller Self-Assessment Form. NOTE: If you are a manufacturer, wholesale drug distributor, or pharmacy licensed by the Board, a separate medical gas license is not required.

Narcotic Treatment Program Facility Controlled Substance Registration Application. This is for methadone clinics.

Nonresident facility change of address/business name Use the online licensing portal to report facility address or name change. NOTE: Cannot be used if there is a change of ownership, or for a change of physical location for facilities that compound sterile preparation/product delivered into NM (new application required).

Nonresident Pharmacy:  as defined in regulation part 6.24. A nonresident pharmacy is a pharmacy located outside New Mexico that ships, mails, or delivers in any manner prescription drugs to New Mexico patients or consumers. A policy and procedure manual is required with the initial application. For the requirements of a nonresident policy and procedures manual please review regulation part 6.24, linked above.

• Nonresident Pharmacy Application (non-sterile)
• Nonresident Pharmacy Application STERILE 
• Nonresident Pharmacy Self-Assessment Form

Outsourcing Facility Application as defined in regulation 16.19.37. An outsourcing facility may or may not be located within New Mexico. A facility that is currently registered with the Food and Drug Administration (FDA) as an outsourcing facility under Section 503B of the Federal Food, Drug, and Cosmetic Act, and that meets the requirements of that agency to engage in the compounding and distribution of sterile drugs.

Outsourcing Facility Self-Assessment Form

Pharmacist Clinician as defined in regulation part 4.17. You will need the patient contact log and instructions:

1. Patient Contact Log Instructions
2. Patient Contact Log
3. Changes to Previously Approved Protocol

Pharmacist Clinician Supervising Physician Certificate Renewal. FAQ for Renewal Process, effective April 2023.

Pharmacy Application as defined in regulation part 6, Procedure for initial in-state pharmacy licensing.

Pharmacy Intern Registration as defined in regulation part 5. The intern packet is six different forms:

1. Location to get approved name tag
2. Intern evaluation of preceptor form
3. Form to report hours earned
4. Preceptor evaluation of intern form
5. Preceptor application form

Pharmacist New Application as defined in regulation part 4.

Pharmacist Affidavit must be completed with initial pharmacist registration.

Pharmacist Application By Examination

Provisional Pharmacist License Application.  (Reciprocity)

Practitioner’s Controlled Substance Registration Application for individuals who are allowed to prescribe controlled substances. This license is required before the DEA will issue a federal controlled substance license.

Preceptor Application as defined in regulation part 5, for pharmacists supervising pharmacy interns.

Remodel or Relocation Application There is no fee for this, but you will also need a request for inspection form.

Request for Inspection

School Based Emergency Medicine (SBEM) Class D Clinic Application. The initial application contains a one-time $30.00 request-for-inspection fee. You do not pay this fee if you are renewing your registration. For your convenience, you may use the NMBOP approved SBEM Class D clinic Policy and Procedure manual. Also, you may obtain the SBEM Class D Clinic Annual Self-Assessment form.
               Albuterol MDI Perpetual Inventory Form
               Epinephrine Auto-Injector Perpetual Inventory Form
               Drug Storage Area Temperature Log
               Quarterly Inspection & Out of Temperature Range Log

Seller or Dispenser of Contact Lenses Application

Technician Application as defined in regulation part 22. Technicians must complete the Technician Training Record form below.

Technician Training Record Form required to be in every pharmacy where a technician works. Defined in regulation part 22.

Technician Frequently Asked Questions

Wholesale Drug Distributor Application defined in regulation part 8;  and 9. For companies distributing drugs within New Mexico.

Licenses issued by the New Mexico Board of Pharmacy may now be renewed online through the licensing portal. If you are a first time user, please see the instructions below. Note that you may renew your license beginning seventy-five days before the license expiration date.

To Renew:

1. Visit https://nmrldlpi.force.com/bcd/s
   • • First time users, click the “Self Register” link and go to step 2.
     • If you already have an account, proceed to Step 4.
2. Fill out the presented form and click “Register.”
3. Once you successfully complete your registration form, you will receive an email (at the email address you entered) from noreply.rldlicensing@rld.nm.gov that will allow you to set your password. (If you do not see the email, please check your inbox or spam/junk folder.)
4. After setting your password, you can then enter the portal and renew your license.
5. Once renewed, please print the electronic copy of your license, which you may use as your official license.

Please note: If you have completed the steps above, and upon entering the portal, you do not see your license information, you will need to email the RLD IT Support Team with the following information:

• Email to: pharmacy.board@rld.nm.gov 
• Subject line: Renewal Registration Complete
• Within the body of the email, please include your name and license number.

The RLD IT Support Team will link your registration with your license and notify you by email when this is complete. Then you can log in and renew your license.

Thank you for your patience as we modernize our licensing platforms to better serve you!

Reciprocity Forms

NAPLEX, MPJE, and FPGEC Information

Pharmacy Technicians

Forms

Protocols