Pharmacy ownership and PIC eligibility checklist

Independent Pharmacy | PublicProof Academy working document

Confirms the ownership structure and pharmacist-in-charge meet your state's rules before you form the entity or apply.

Business

State or jurisdiction

Prepared on

Owner

Official source saved

Next review

Ownership rules

Read my state row for ownership limits (e.g., ND majority pharmacist ownership, RI prescriber cap of 10%)
List every owner, member, officer and percentage
Confirm no prescriber ownership or financial interest that my state restricts
Background or fingerprint requirements identified for each owner
Ownership chart saved for future change-of-ownership filings

Pharmacist-in-charge

PIC holds an active pharmacist license in this state
PIC has no disqualifying discipline
PIC statement or attestation form identified (e.g., MO notarized, TN PH-4012)
Relief pharmacists identified to cover all open hours
Written agreement on PIC duties and notice period

Use rule: Education and organization only. Record the agency, official source, checked date, cost, proof saved and responsible person for every consequential requirement. Unknown means stop and confirm. Example rows are labeled EXAMPLE and are not your data.