(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 who will serve as the responsible individual of the wholesale drug distributor with the board and who is actively involved in and aware of the actual daily operation of the wholesale drug distributor;

(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.