NAC639.6942. Application for license; license required for each location; notification of change in information; license nontransferable; expiration.

     1. An applicant for a license to engage in business as a medical products provider or medical products wholesaler must submit an application to the Board on a form furnished by the Board. The application must include:

     (a) The name, mailing address and telephone number of the applicant;

     (b) The street address of the business or facility of the applicant, if different from the mailing address of the applicant;

     (c) All trade or business names used by the applicant;

     (d) The type of ownership or operation of the business or facility;

     (e) The name, address, telephone number and social security number of the person who manages the business or facility of the applicant;

     (f) If the applicant is:

          (1) A natural person, the name of the person;

          (2) A partnership, the name of the partnership and the name of each general or limited partner;

          (3) A corporation, the name and title of each officer and director of the corporation, the corporate name, the state of incorporation and the name of the corporation’s parent company, if any; or

          (4) A sole proprietorship, the name of the sole proprietor and the name of the business entity;

     (g) Proof of insurance required pursuant to NAC 639.6946;

     (h) The hours and days that the business will be regularly operated; and

     (i) All Medicare and Medicaid provider numbers registered to the business or its owner.

     2. If a medical products provider sells, leases or otherwise provides medical products at more than one location, it must obtain a license for each location where medical products are sold, leased or otherwise provided.

     3. An applicant shall notify the Board in writing of any change in the information required pursuant to this section within 30 days after the change occurs.

     4. A license issued by the Board pursuant to this section:

     (a) Is not transferable; and

     (b) Expires on October 31 of each even-numbered year unless renewed before that date.

     (Added to NAC by Bd. of Pharmacy by R008-01, eff. 11-1-2001)