(b) The above individuals shall, in a manner prescribed by rules promulgated by the Board of Pharmacy pursuant to this article, report the following information, as applicable:
- (1) The name, address, pharmacy prescription number, and Drug Enforcement Administration controlled substance registration number of the dispensing pharmacy or the dispensing physician or dentist;
- (2) The full legal name, address, and birth date of the person for whom the prescription is written;
- (3) The name, address, and Drug Enforcement Administration controlled substances registration number of the practitioner writing the prescription;
- (4) The name and national drug code number of the Schedule II, III, IV, and V controlled substance or opioid antagonist dispensed;
- (5) The quantity and dosage of the Schedule II, III, IV, and V controlled substance or opioid antagonist dispensed;
- (6) The date the prescription was written and the date filled;
- (7) The number of refills, if any, authorized by the prescription;
- (8) If the prescription being dispensed is being picked up by someone other than the patient on behalf of the patient, information about the person picking up the prescription as set forth on the person’s government-issued photo identification card shall be retained in either print or electronic form until such time as otherwise directed by rule promulgated by the Board of Pharmacy; and
- (9) The source of payment for the controlled substance dispensed.