The following information is required from each wholesale drug distributor applying for licensure or renewal:
the name, full business address, and telephone number of the licensee;
all trade or business names used by the licensee;
addresses, telephone numbers, and the names of contact persons for all facilities used by the licensee for the storage, handling, and distribution of drugs;
whether the ownership or operation is a partnership, corporation, or sole proprietorship; and
the name of the owner and operator of the licensee, including:
if an individual, the name of the individual;
if a partnership, the name of each partner, and the name of the partnership;
if a corporation, the name and title of each corporate officer and director, the corporate names, and the name of the state of incorporation; and
if a sole proprietorship, the full name of the sole proprietor, and the name of the business entity.
Changes in any information in items A to E shall be submitted to the board within 30 days of the change.
16 SR 1913
September 21, 2011