Code of Maine Rules › 02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION › 392 - MAINE BOARD OF PHARMACY › Part 5 - LICENSE DENIAL AND PROFESSIONAL DISCIPLINE › Chapter 34 - LICENSURE OF RETAIL SUPPLIERS OF MEDICAL OXYGEN › Section 392-5-34-4 - Licensure

Current through 2024-29, July 17, 2024
1.
Application; Fees
An application for licensure as a retail supplier of
					 medical oxygen must be filed on forms provided by the board. The application
					 must be accompanied by the application and license fees required by Chapter 10,
					 Section
					 5(27) of the rules
					 of the Department of Professional and Financial Regulation, Office of
					 Professional and Occupational Regulation, entitled "Establishment of License
					 Fees." Except as described in Section
					 3 of this chapter, incomplete
					 applications will not be accepted and will be returned to the applicant. The
					 applicant shall provide the following information:
A. The name, physical address, contact
				  address, telephone number, email address and world wide web address of the
				  retail supplier of medical oxygen;
B. All trade or business names used by the
				  retail supplier of medical oxygen;
C. The names of the owner of the retail
				  supplier of medical oxygen, including:
(a) If
				  a partnership, the name, contact address, telephone number and employer
				  identification number of the partnership, and the name and contact address of
				  each partner;
(b) If a corporation,
				  the name, contact address, telephone number and employer identification number
				  of the corporation; the name of the parent company, if any; the name, contact
				  address and title of each corporate officer and director; the name and contact
				  address of each shareholder owning 10% or more of the voting stock of the
				  corporation, including over-the-counter stock, unless the company is traded on
				  a major stock exchange and not over-the-counter; a certificate of existence
				  from the corporation's state of organization and, for corporations not
				  organized under Maine law, a certificate of authority from the Maine Secretary
				  of State;
(c) If the applicant is a
				  limited liability company, the name, contact address, employer identification
				  number, telephone number, fax number and email address of the limited liability
				  company; the names and mailing addresses of each member and manager; a
				  certificate of existence from the Maine Secretary of State or, for limited
				  liability companies not organized under Maine law, a certificate of authority
				  or certificate of qualification from the Maine Secretary of State; and the name
				  of the member or manager who will be representing the applicant in matters
				  before the board.
(d) If a sole
				  proprietorship, the name, contact address, telephone number and social security
				  number of the sole proprietor and the name of the business entity;
D. The job title, name, address,
				  telephone number, email address and emergency contact information of the person
				  responsible for operation of the retail supplier of medical oxygen;
E. The days and hours of operation of the
				  retail supplier of medical oxygen;
F. A scaled drawing of the facility
				  demonstrating sufficient space for the proper carrying on of the business of a
				  retail supplier of medical oxygen. The drawing must identify the use of all
				  space within the facility;
G. Such
				  other information as the board may require.