R9-9A-104. Application for Licensure

A. A person may not act as a procurement organization in this state unless the person is licensed by the Department as a procurement organization. B. An applicant for a procurement organization license shall submit to the Department an application that contains: 1. The following, according to A.R.S. § 36-851.01(A), in a Department-provided format: a. The applicant’s name, mailing address, email address, and telephone number; b. The name or proposed name of the procurement organization, including the: i. Physical address; ii. Mailing address, if different from the physical address; iii. Telephone number; iv. Email address; and v. Tax ID number; c. Whether the applicant is a business organization and, if so, the type of business organization; d. Whether the applicant is accredited as a procurement organization; e. If the applicant is not accredited as a procurement organization, the name, email address, telephone number, and professional license number of the medical director; f. Whether the facility is ready for a licensing inspection by the Department; g. If the facility is not ready for a licensing inspection specified in subsection (B)(1)(f), the date the facility will be ready for a licensing inspection; h. The name, title, and contact information of an individual acting on behalf of the applicant, as specified in R9-9A-103; i. Whether the applicant complies with local zoning ordinances, building codes, and fire codes; j. Whether the applicant agrees to allow the Department to submit supplemental requests for information under R9-9A-109; and k. The applicant’s signature and the date signed; 2. If applicable, documentation that the procurement organization is accredited; 3. A floor plan, drawn to scale, of each building where the procurement organization will be located, showing the function of each room; 4. Documentation for the applicant that complies with A.R.S. § 41-1080; 5. Documentation that shows that the applicant is in good standing with the Arizona Corporation Commission; and 6. An application fee of $2,000. C. Upon receipt of the application in subsection (B), the Department shall conduct an inspection of the procurement organization, if applicable. D. The Department shall issue or deny a license to an applicant as specified in R9-9A-109.