(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) addresses, telephone numbers, and the name of contact persons for all facilities used by the licensee for the storage, handling, and distribution of drugs;

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

(e) the name, address, and telephone number of the owner and operator of the licensee, including:

(i) if an individual, the name, address, and telephone number of the individual;

(ii) if a partnership, the name, address, telephone number, and ownership percentage of each partner, and the name of the partnership;

(iii) if a corporation, the name, address, telephone number, and ownership percentage and title of each corporate officer and director, the corporate names, and the name of the state of incorporation; and

(iv) if a sole proprietorship, the full name, address, and telephone number of the sole proprietor, and the name of the business entity;

(f) the name and address of the five highest-ranking employees responsible for daily operations;

(g) the name and address of the five largest shareholders owning at least 5 percent of the total shares;

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

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

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

(2) Any changes in information contained in items (a) through (e) above shall be submitted to the board within 30 days of the change.