MINIMUM INFORMATION REQUIRED FOR LICENSURE

The following information is required from each wholesale drug distributor applying for licensure or renewal: A. the name, full business address, and telephone number of the licensee; B. all trade or business names used by the licensee; C. addresses, telephone numbers, and the names of contact persons for all facilities used by the licensee for the storage, handling, and distribution of drugs; D. whether the ownership or operation is a partnership, corporation, or sole proprietorship; and E. the name of the owner and operator of the licensee, including: (1) if an individual, the name of the individual; (2) if a partnership, the name of each partner, and the name of the partnership; (3) 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 (4) 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.