Community Pharmacy Licence Variation Application

About this form

This form is to be used to apply for a Variation to a Community Pharmacy Licence under the Public Health Act 1997 (the Act). You can access the Act and its regulation at the Legislation Register.

Important Information

You cannot change the premises location using this form. A new application must be submitted.

You cannot use this form to transfer the ownership of a Community Pharmacy Licence. A Transfer of Ownership application must be submitted.

Attachments

The original licence certificate must accompany this application.

If the Variation is a Refurbishment, a floor plan showing the layout of all fixtures and fittings of the premises must be attached.

Contact

Health Protection Service

Phone: (02) 6205 1700
Email: hps@act.gov.au

Your personal information

Access Canberra uses this form to collect information which is necessary to allow the ACT Government to provide services to you. Personal Information may be used or disclosed in accordance with the Information Privacy Act 2014.

For details on the collection of personal information in this form please refer to the Access Canberra Information Collection Notice. If you have questions about how your information will be handled please see the Access Canberra Privacy Policy and the ACT Health Privacy Notice or contact us.