Okla. Admin. Code § 365:25-29-5

Current through Vol. 42, No. 7, December 16, 2024

Section 365:25-29-5 - Forms and contents of application for PBM license

An application for PBM License shall be on a form provided by the Commissioner and shall include:

(1) The identity of the PBM and any company or organization controlling the operation of the PBM, including the name, business address, and contact person for the PBM and the controlling entity. For purposes of this subsection, "control" or "controlling" means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of the PBM, whether through the ownership of voting securities, by contract or otherwise, unless, for an individual, the power is the result of an official position with or corporate office held by the person;

(2) The name and address of the corporate officers and directors, members and managers (if an LLC), or names of all partners (if a partnership) of the applicant PBM;

(3) A license fee in the amount of One Thousand Dollars ($1,000.00);

(4) A "Certificate of Incorporation" or comparable organizational document from the domiciliary state of the PBM;

(5) In the case of a PBM domiciled outside the State of Oklahoma, a certificate that the PBM is in good standing in the state of domicile or organization;

(6) A report of the details of any suspension, sanction, penalty or other disciplinary action relating to the PBM and its officers and directors;

(7) The name and address of the agent of record for services of process in Oklahoma;

(8) The number of total covered individuals or lives served under all of the PBM's contracts or agreements in Oklahoma;

(9) The most recently concluded fiscal year-end financial statements for the PBM and its controlling entity, which statements have been audited by an independent certified public accountant (CPA) under U.S. generally accepted accounting principles (GAAP); and

(10) A certificate signed by an Executive Officer of the PBM attesting to the accuracy of the information contained in the filing.

Okla. Admin. Code § 365:25-29-5

Adopted by Oklahoma Register, Volume 32, Issue 24, September 1, 2015, eff. 9/15/2015

Amended by Oklahoma Register, Volume 37, Issue 24, September 1, 2020, eff. 9/11/2020