Section 16-95-21 - Forms, documentation, and notification(a) An application for license or permit shall be made under oath on forms provided by the board and shall not be considered complete unless accompanied with the required documentation and fees. It shall be each applicant's responsibility to furnish all information and any documentation requested by the board.(b) The application form may require the applicant and any personnel of the applicant to provide the following: (1) The applicant's full name;(2) A statement that the applicant has attained the age of majority;(3) The applicant's current business or mailing address for publication, and the applicant's current residence address;(4) The applicant's social security number;(5) The applicant's educational history and evidence of the education;(6) The date and place of any conviction of a crime directly related to the practice of pharmacy, drugs, drug samples, wholesale or retail drug distribution, or distribution of controlled substances, unless the conviction has been expunged or annulled or is otherwise precluded from consideration by section 831-3.1, HRS;(7) The state or states or United States territory in which the applicant is currently licensed, and any information regarding any disciplinary proceedings pending or disciplinary actions taken by any state or jurisdiction against the license;(8) A statement that the applicant is a United States citizen or an alien authorized to work in the United States;(9) The names, addresses, phone numbers, and social security numbers of corporate officers or partners or other personnel of the applicant;(10) Verification that the corporation, partnership, or entity is properly registered with BREG;(11) Verification that the trade name, if any, is properly registered with BREG;(12) The name and license number of the pharmacist in charge of the prescription area and the name or names and license number or numbers of any other pharmacists employed;(13) The name, position, and title of any person responsible for the distribution of drugs; and(14) Any other information the board may require to investigate the applicant's qualifications for license or permit.(c) Any requirement that the board provide notice to licensees or permittees shall be deemed met if notice is sent to the address on file with the board.(d) Any change in the application or of any information filed with the board shall be reported to the board, in writing, within ten days of the change.(e) Upon closure of a pharmacy located in this State, the pharmacy shall: (1) Provide written notice to the board within ten days; and(2) Return all indicia of licensure. [Eff 5/16/64; am and ren § 16-95-21, 6/22/81; am and comp 12/24/92; comp 12/25/04] (Auth: HRS § 461-4.5) (Imp: HRS §§ 461-4.5, 461-5, 461-6, 461-7, 461-14, 461-15, Act 196 SLH 1992)
The substance of this section is based in part upon sections 16-95-13 and 16-95-35. [Eff 5/12/64; am and ren §§ 16-95-13, 16-95-35, 6/22/81; R 12/24/92][am and comp 06/22/15; Am and Comp 8/15/2016] (Imp: HRS § 461-8.6);
The substance of this section is based in part upon sections 16-95-13 and 16-95-35. [Eff 5/12/64; am and ren §§ 16-95-13, 16-95-35, 6/22/81; R 12/24/92]