Applicants must complete the following information as part of the application form:

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

5. (5) The name of the owner or operator, or both, of the applicant, 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 name and title of each corporate officer and director, the corporate names, the name of the state of incorporation, and the name of any parent company;
   4. (d) If a sole proprietorship, the full name of the sole proprietor and the name of the business entity;

6. (6) Statements pertaining to factors that may determine eligibility for licensure, including if, in the last seven years any of the following have occurred:

   1. (a) Any convictions of the applicant under any federal, state, or local laws relating to drug samples, wholesale or retail drug distribution, or distribution of controlled substances;
   2. (b) Any felony convictions of the applicant under federal, state, or local laws;
   3. (c) The applicant's past experience in the manufacture or distribution of prescription drugs, including controlled substances;
   4. (d) Suspension or revocation by federal, state, or local government of any license currently or previously held by the applicant for the manufacture or distribution of any drugs, including controlled substances;
7. (7) A statement certifying that the applicant will operate in a manner prescribed by federal and state law and rules adopted by the board;
8. (8) The type of distribution;
9. (9) The type of products distributed; and
10. (10) The type of entity to which the products are distributed.

Source: 18 SDR 95, effective November 25, 1991; 45 SDR 86, effective December 24, 2018.

General Authority: SDCL 36-11A-14(1) ,(3).

Law Implemented: SDCL 36-11A-7 , 36-11A-8 , 36-11A-28, 36-11A-35 .

Prior versions effective: 1991-11-25.