Notification of Disassociation of PIC/DRIC/RMG
A licensee is required to notify the Board when ceasing to act as a pharmacist-in-charge (PIC), designated representative-in-charge (DRIC) or responsible manager (RMG). Below are disassociation forms available as a convenience and is intended to assist licensees in providing the required notification to the Board. No fee is required for the notification of disassociation. Completed forms may be submitted to the Board via mail or e-mail by using the email address provided on the form. Additionally, you may submit a contact form to the Board, regarding the details of your disassociation.
- Pursuant to BPC 4101(a), any pharmacist-in-charge who ceases to act as the pharmacist-in-charge of any pharmacy shall notify the Board in writing within 30 days of the date of that change in status.
Notification of PIC Disassociation (17A-121) - (PDF) - Pursuant to BPC 4101(b), any designated representative-in-charge who ceases to act as the designated representative-in-charge at any wholesaler or veterinary food-animal drug retailer shall notify the Board in writing within 30 days of the date of that change in status.
Notification of DRIC Disassociation (17A-122) - (PDF) - Pursuant to BPC 4101(c), any responsible manager who ceases to act as the responsible manager at any third-party logistics provider shall notify the Board in writing within 30 days of the date of that change in status.
Notification of RMG Disassociation (17A-123) - (PDF)
Send the disassociation notification via mail, fax or send us a message.
Notification Change of PIC/DRIC/RMG/Professional Director
A facility is required to notify the Board of the proposed pharmacist-in-charge (PIC), designated representative-in-charge (DRIC), responsible manager (RMG), or professional director within 30 days of the change. This notification requires a fee. Review instructions on the appropriate form for any additional requirements when submitting the change notification.
Change of Pharmacist-in-Charge (PIC)
Business and Professions Code section 4113(d), 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 PIC. The proposed replacement PIC 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 PIC is approved by the board.” The PIC shall be responsible for a pharmacy's compliance with all state and federal laws and regulations pertaining to the practice of pharmacy.
If the 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. You may request a set of the board fingerprint cards if you do not hold a current California pharmacist license and are not currently associated as a PIC to a nonresident pharmacy.
Change of Pharmacist-in-Charge Application
Change of Designated Representative-in-Charge (DRIC)
Business and Professions Code Sections 4160(f), states, “A wholesaler shall notify the board in writing, on a form designed by the board, within 30 days of the date when a designated representative-in-charge ceases to act as the designated representative-in-charge, and shall on the same form propose another designated representative or pharmacist to take over as the designated representative-in-charge. The proposed replacement designated representative-in-charge shall be subject to approval by the board. If disapproved, the wholesaler shall propose another replacement within 15 days of the date of disapproval, and shall continue to name proposed replacements until a designated representative-in-charge is approved by the board.” The DRIC serves as supervisor or manager and is responsible for ensuring the wholesaler’s or veterinary food-animal drug retailer’s compliance with all the state and federal laws and regulations pertaining to practice and the applicable license.
If the DRIC is a pharmacist in the home state of the nonresident wholesaler license, is currently associated with an active nonresident wholesaler license, and has electronic fingerprints on file with the California State Board of Pharmacy, new fingerprints may not be required. You may request a set of the board fingerprint cards if you do not hold a current California pharmacist license and are not currently associated as a DRIC to a nonresident wholesaler.
Change of Designated Representative-in-Charge Application
Request Fingerprint CardsChange of Responsible Manager (RMG)
Business and Professions Code Sections 4160(g), states, “A third-party logistics provider shall notify the board in writing, on a form designed by the board, within 30 days of the date when a responsible manager ceases to act as the responsible manager, and shall on the same form propose another designated representative-3PL to take over as the responsible and shall on the same form propose another designated representative-3PL to take over as responsible manager. The proposed replacement responsible manager shall be subject to approval by the board. If disapproved the third-party logistics provider shall propose another replacement within 15 days of the date of disapproval, and shall continue to name proposed replacements until a responsible manager is approved by the board.”
The responsible manager is responsible for ensuring compliance of the licensed place of business with state and federal laws with respect to dangerous drugs and dangerous devices received by, stored in, or shipped from the licensed place of business of the third-party logistics provider.
Change of Responsible Manager Application
Change of Professional Director in a Licensed Clinic
Business and Professions Code section 4182 and 4192, states, “Licensed clinics shall notify the board within 30 days of any change in professional director on a form furnished by the board. The professional director is responsible for the safe, orderly, and lawful provision of pharmacy services.
Change of Professional Director Application
Duplicate/Replacement License
To request a duplicate or replacement license, submit an Application for a Duplicate/Replacement License form (17A-28) and issuance fee, if applicable. Licenses are mailed within four weeks from the time of issuance or renewal to the address of record on file with the board. To verify your address of record on file with the board, please complete a license search on the board’s website.
Application for a Duplicate/Replacement License