Virginia Administrative Code › Title 18 - PROFESSIONAL AND OCCUPATIONAL LICENSING › Agency 110 - BOARD OF PHARMACY › Chapter 50 - Regulations Governing Wholesale Distributors, Manufacturers, Third-Party Logistics Providers, and Warehousers › Part II - Wholesale Distributors and Third-y Logistics Providers › Section 18VAC110-50-70 - Minimum required information

Current through Register Vol. 40, No. 24, July 15, 2024
A. The application form for a new license,
				  registration as a nonresident wholesale distributor or a nonresident
				  third-party logistics provider, or permit as a third-party logistics provider
				  or any change of ownership shall include at least the following information:
1. The name, full business address, and
				  telephone number of the applicant or licensee, registrant, or permit holder and
				  name and telephone number of a designated contact person;
2. All trade or business names used by the
				  applicant or licensee, registrant, or permit holder;
3. The federal employer identification number
				  of the applicant or licensee, registrant, or permit holder;
4. The type of ownership and name of the
				  owner of the entity, including:
a. If an
				  individual, the name, address, and social security number or control
				  number;
b. If a partnership, the
				  name, address, and social security number or control number of each partner who
				  is specifically responsible for the operations of the facility, and the name of
				  the partnership and federal employer identification number;
c. If a corporation:
(1) The name and address of the corporation,
				  federal employer identification number, state of incorporation, and the name
				  and address of the resident agent of the corporation;
(2) The name, address, social security number
				  or control number, and title of each corporate officer and director who is
				  specifically responsible for the operations of the facility;
(3) For nonpublicly held corporations, the
				  name and address of each shareholder that owns 10% or more of the outstanding
				  stock of the corporation;
(4) The
				  name, federal employer identification number, and state of incorporation of the
				  parent company;
d. If a
				  sole proprietorship, the full name, address, and social security number or
				  control number of the sole proprietor and the name and federal employer
				  identification number of the business entity;
e. If a limited liability company, the name
				  and address of each member, the name and address of each manager, the name of
				  the limited liability company and federal employer identification number, the
				  name and address of the resident agent of the limited liability company, and
				  the name of the state in which the limited liability company was
				  organized;
5. Name,
				  business address and telephone number, social security number or control
				  number, and documentation of required qualifications as stated in
				  18VAC110-50-80
				  of the person who will serve as the responsible party;
6. A list of all states in which the entity
				  is licensed, registered, or permitted to purchase, possess, and distribute
				  prescription drugs, and into which it ships prescription drugs;
7. A list of all disciplinary actions imposed
				  against the entity by state or federal regulatory bodies, including any such
				  actions against the responsible party, principals, owners, directors, or
				  officers over the last seven years;
8. A full description, for nonresident
				  wholesale distributors, including the address, square footage, security and
				  alarm system description, temperature and humidity control, and other relevant
				  information of the facility or warehouse space used for prescription drug
				  storage and distribution; and
9. An
				  attestation providing a complete disclosure of any past criminal convictions
				  and violations of the state and federal laws regarding drugs or devices or an
				  affirmation and attestation that the applicant has not been involved in, or
				  convicted of, any criminal or prohibited acts. Such attestation shall include
				  the responsible party, principals, owners, directors, or officers.