20:67:02:02.  Required application information. Applicants must complete the following information as part of the application form:

 

          (1)  The name, full business address, and telephone number of the applicant;

 

          (2)  All trade or business names used by the applicant;

 

          (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)  The type of ownership or operation, that is, partnership, corporation, or sole proprietorship;

 

          (5)  The name of the owner or operator, or both, of the applicant, including:

 

               (a)  If a person, the name of the person;

               (b)  If a partnership, the name of each partner and the name of the partnership;

               (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;

               (d)  If a sole proprietorship, the full name of the sole proprietor and the name of the business entity;

 

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

 

               (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;

               (b)  Any felony convictions of the applicant under federal, state, or local laws;

               (c)  The applicant's past experience in the manufacture or distribution of prescription drugs, including controlled substances;

               (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)  A statement certifying that the applicant will operate in a manner prescribed by federal and state law and rules adopted by the board;

 

          (8)  The type of distribution;

 

          (9)  The type of products distributed; and

 

          (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.