Section 392-2-8-1 - Application; Fees An application for licensure as a retail pharmacy must be filed on forms provided by the board. The application must be accompanied by the application and license fees required by Chapter 10, Section 5(27) of the rules of the Department of Professional and Financial Regulation, Office of Professional and Occupational Regulation, entitled "Establishment of License Fees." Incomplete applications will not be accepted and will be returned to the applicant. The applicant shall provide the following information:
1. The name, address, telephone number and email address of the person responsible for submission of the application;2. The name under which the retail pharmacy will operate, and the physical address, contact address, telephone number, email address and world wide web address of the retail pharmacy;3. All trade or business names used by the retail pharmacy;4. The name(s) of the owner and/or operator of the retail drug pharmacy, including: A. If a partnership, the name, contact address, telephone number and employer identification number of the partnership, and the name and contact address of each partner;B. If a corporation, the name, contact address, telephone number and employer identification number of the corporation; the name of the parent company, if any; the name, contact address and title of each corporate officer and director; the name and contact address of each shareholder owning 10% or more of the voting stock of the corporation, including over-the-counter stock, unless the stock is traded on a major stock exchange and not over-the-counter; a certificate of existence from the corporation's state of organization and, for corporations not organized under Maine law, a certificate of authority from the Maine Secretary of State;C. If a limited liability company, the name, contact address, employer identification number, telephone number, fax number and email address of the limited liability company; the names and mailing addresses of each member and manager; a certificate of existence from the Maine Secretary of State or, for limited liability companies not organized under Maine law, a certificate of authority or certificate of qualification from the Maine Secretary of State; and the name of the member or manager who will be representing the applicant in matters before the board;D. If a sole proprietor, the name, contact address, telephone number and social security number of the sole proprietor and the name of the business entity.5. The hours of operation of the retail pharmacy during which a pharmacist will be on duty;6. If the pharmacy is located within a retail store, the hours of operation of the retail store;7. The DEA number, when obtained;8. The name and license number of the pharmacist in charge of the retail pharmacy;9. Verification of the following facilities, apparatus and equipment: * Adequate lighting
* Sink with hot and cold running water
* Rest room facilities
* Refrigerator
* Rx weights (if required by type of Rx balance used)
* Rx balance
* Spatula, non-metal (1)
* Spatula, metal (2)
* Mortar and pestle (2)
* Graduates assorted (4)
* Safety cap Rx containers
* Appropriate Rx labels
* Professional reference library, including drug interactions (in any format)
* Current Maine pharmacy laws and rules (in any format)
10. A scaled drawing and floor plan of the retail pharmacy which details the usage of each area. If the licensed area is part of a larger retail store, the applicant shall include an additional scaled drawing and floor plan of the entire establishment showing the relative position of the licensed area and the location of all entrances, bathrooms, and storage areas;12. Demonstration of compliance with the security barrier, alarm and security camera requirements of Chapter 13, Section 6 of the board's rules;13. Demonstration of compliance with the signage requirement of Chapter 13, Section 8 of the board's rules;14. Upon request of the board, all plumbing permits, electrical permits, certificates of occupancy and other documents necessary to show full compliance with all federal, state and local laws and rules; and15. Such other information as the board may require.02-392 C.M.R. ch. 2, § 8-1