(1) The following information shall be supplied by each applicant for wholesale drug distributor licensure or renewal:

(a) the name, full business address, and telephone number of the licensee;

(b) all trade or business names used by the licensee;

(c) the name, address, telephone number, and title of the designated person in charge of the facility;

(d) whether the ownership or operation is a partnership, corporation, or sole proprietorship;

(e) proof of registration with the Montana Secretary of State;

(f) if out-of-state, proof of corresponding licensure in good standing in the state in which the applicant resides;

(g) the federal tax identification number of the company; and

(h) written documentation in compliance with the information required under 37-7-604, MCA.

(2) Any changes in information contained in (1) shall be submitted to the board within 30 days of the change. Any changes in location or ownership require that a new license application be filed with the board at least 30 days prior to the change.