(a) In order to more fully identify the owner or owners of companies or corporations that apply to be or currently are providers of incontinence medical supplies, within 30 days of the receipt of a request from the department, or a request to the department from the Department of Justice, the applicant or provider shall provide, as part of the application process or as a condition of continued participation in the Medi-Cal program, the following:

1. (1) The name of the corporation, the official titles of the applicants, and a list of all the corporate officers.
2. (2) The California driver’s license or California identification card number of the applicants, coowners, corporate officers, and financially interested parties.
3. (3) The applicant’s business permit control number, issued by the State Board of Equalization, for the business location where services are rendered to the public.
4. (4) A statement of all current sources of capital, identity of all investors, disclosure of all manufacturers, suppliers, and providers currently doing business with the applicant, and disclosure of all entities to whom the applicant has extended a line of credit.
5. (5) A statement certifying that all information supplied pursuant to this section is accurate.