| | |
(3)__If a corporation, the name and title of each | | corporate officer and director, all corporate names and | | the state of incorporation; |
|
| | | F.__A list of all licenses and permits issued to the | | applicant by any other state that authorize the applicant to | | purchase or possess prescription drugs; |
|
| | | G.__The name of the manager and the next 4 highest ranking | | employees responsible for prescription drug wholesale | | operations of the facility for which the applicant is | | applying for a license or renewal under this section; |
|
| | | H.__The name of the applicant's designated representative | | for the facility for which the applicant is applying for a | | license or renewal under this section; and |
|
| | | I.__A set of fingerprints and a personal information | | statement for every person listed under paragraphs G and H | | including: |
|
| | | (1)__Every place of residence for the person for the | | previous 7 years; |
|
| | | (2)__The person's date and place of birth; |
|
| | | (3)__Every occupation, position of employment or office | | held for the previous 7 years; |
|
| | | (4)__The principal business and address of every | | organization in which the person held a position of | | employment or office under subparagraph 3; |
|
| | | (5)__Whether in the previous 7 years the person has | | been subject to a proceeding for the revocation of a | | license and for every proceeding listed the nature and | | disposition of the proceeding; |
|
| | | (6)__Whether in the previous 7 years the person has | | been temporarily or permanently enjoined by a court of | | competent jurisdiction from violating state or federal | | law regulating the possession, control or distribution | | of prescription drugs and the details for every | | injunction listed; |
|
| | | (7)__A description of the involvement of the person with every | | business or investment that manufactured, administered, | | prescribed, distributed or stored |
|
|