Louisiana Board of Pharmacy - State of Louisiana

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photo-pharmacist State of Louisiana

Forms & Applications

Durable Medical Equipment (DME) Providers

 

301 ~ Application for New Durable Medical Equipment (DME) Permit


302 ~ Application for Renewal of DME Permit (in-state) for Year 2020-2021


302-NR ~ Application for Renewal of Nonresident DME Permit for Year 2020-2021


302-L ~ Application for Late Renewal of DME Permit (in-state) for Year 2020-2021


302-NR-L ~ Application for Late Renewal of Nonresident DME Permit for Year 2020-2021


304 ~ Application for Relocation of DME Permit 


065 ~ Notice of Change of Owner's Managing Officer (OMO)