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Change Of Permit Pharmacy Hospital Clinic Non-Resident Pharmacy Licensed Correctional Facility (Instructions) Form. This is a California form and can be use in Board Of Pharmacy Statewide.
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Tags: Change Of Permit Pharmacy Hospital Clinic Non-Resident Pharmacy Licensed Correctional Facility (Instructions), 17M-70, California Statewide, Board Of Pharmacy
Effective July 1, 2018, Business and Professions Code section 4201(a) requires the application shall state the information as to each person beneficially interested or any person with management or control over the license. With the addition of management or control over the license, officers/owners of nonprofit corporations are required to have his/her fingerprints completed through the Department of Justice and Federal Bureau of Investigation by utilizing the board222s Live Scan form included with the application or if a person is not residing in California complete the board approved fingerprint cards and submit the $49 fingerprint card processing fee. Please reference Section I of the application instructions below on the requirements for submitting fingerprints. American LegalNet, Inc. www.FormsWorkFlow.com Please note: This does NOT include a physical change of location. A physical changeof location requires a new license application. A change of ownership requires a new license application. American LegalNet, Inc. www.FormsWorkFlow.com NOTE: Change of Ownership: A transfer of beneficial interest in the facility licensed by the board, in a singletransaction or in a series of transactions, to any person or entity, which transfer results in the transferee222s holding 50% or moreof the beneficial interest in the licensed facility shall complete the appropriate licensingapplication and submit all required documents as instructed in a change of ownership application. Allapproved change of ownership applications result in a new license number being issued. American LegalNet, Inc. www.FormsWorkFlow.com Any new person being added to the license as listed below. If a person is currently associated with an active license and has fingerprints already on file with the California State Board of Pharmacy, new fingerprints may not be required. American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com If submittingmultiple changes to a license that fall under both A and Bbelow, the application fee is $100 for each license. American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com NOTE: Change of Ownership:A transfer of beneficial interest in the facility licensed by the board, in a single transaction or in a series of transactions, to any person or entity, which transfer results inthe transferee222s holding 50% or moreof the beneficial interestin the licensed facility shall complete the appropriate licensing application and submit all required documents as instructed in a change of ownership application. All approved change of ownershipapplications result in a new license numberbeing issued. American LegalNet, Inc. www.FormsWorkFlow.com Under penalty of perjury, under the laws of the state of California, each person whose signature appears below, certifies and says: (1) He/she is the applicant, or one of the officers, partners, members, majority owner, or administrator, director, wardenof the applicant named in the foregoing application,duly authorized to make this application on its behalf; (2) that he/she has read the foregoing application and knows the contents thereof and that each and all statements therein made are true; (3) that no person other than the applicant or applicants hasany direct or indirect interest in the applicant222s or applicants222 business to be conducted under the license(s) for which this application is made; and (4) all supplemental statements are true andaccurate American LegalNet, Inc. www.FormsWorkFlow.com