Nevada Form FAQ

What information must be included in the out-of-state pharmacy affidavit?

Agency
Nevada State Board of Pharmacy
Document Type
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NEVADA FORM HELP

What to know about this form

The Nevada out-of-state pharmacy affidavit must include specific multi-state compliance certifications as required by the Nevada State Board of Pharmacy under NAC 639.240. The affidavit certifies that the out-of-state pharmacy meets all Nevada regulatory requirements while operating from another state.

Required Affidavit Components:

  • Pharmacy name, physical address, and home state licensing information
  • Current home state pharmacy license number and expiration date
  • DEA registration number and controlled substance authorization
  • Statement of compliance with Nevada pharmacy laws and regulations
  • Certification of pharmacist-in-charge qualifications and licensing
  • Acknowledgment of Nevada State Board of Pharmacy jurisdiction
  • Attestation of proper prescription dispensing protocols for Nevada patients
  • Declaration of compliance with Nevada prescription transfer requirements
  • Statement regarding multi-state operational standards and quality control
  • Certification that all information provided is accurate and complete

Multi-State Compliance:

The affidavit must demonstrate that the out-of-state pharmacy maintains equivalent or higher standards than Nevada in-state pharmacies, including prescription verification, patient counseling availability, drug storage and handling, record-keeping, and regulatory reporting. This ensures consistent patient safety across state lines.

โœ… Best Practice:

Review all affidavit requirements with your home state Board of Pharmacy and legal counsel before notarization. Lake Mead Mobile Notary provides expert pharmacy affidavit notarization at professional offices, remote locations, and throughout Clark County with verification of proper completion.

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