(a) The Arkansas State Board of Pharmacy requires the following from each wholesale drug distributor as part of the initial licensing procedure and as part of any renewal of such license:

1. (1) The name, full business address, and telephone number of the licensee;
2. (2) All trade or business names used by the licensee;
3. (3) Addresses, telephone numbers, and the names of contact persons for the facility used by the licensee for the storage, handling, and distribution of prescription drugs;
4. (4) The type of ownership or operation, i.e., partnership, corporation, or sole proprietorship; and

5. (5) The names of the owner and/or operator of the licensee, including:

   1. (A) If a person, the name of the person;
   2. (B) If a partnership, the name of each partner and the name of the partnership;
   3. (C) If a corporation, the:

(i) Name and title of each corporate officer and director;

1. (ii) Corporate names;

   1. (iii) Name of the state of incorporation; and

      1. (iv) Name of the parent company, if any; or

   2. (D) If a sole proprietorship, the:

      1. (i) Full name of the sole proprietor; and
      2. (ii) Name of the business entity.

(b) Where operations are conducted at more than one (1) location by a single wholesale distributor, each such location shall be licensed by the board.

1. (c) Changes in any information on the application for licensure shall be submitted to the board within thirty (30) days after such change.