Mich. Admin. Code R. 500.33 - Application contents and fee; supplemental documents
Rule 3.
(1) To
obtain a license, an applicant shall submit the following:
(a) An application on a form provided by the
director.
(b) The supplemental
documents required under section 11(2) of the act, MCL
550.821, and this rule.
(c) A nonrefundable application fee in an
amount established by the director by bulletin. The director shall not adjust
the application fee more than once per year.
(2) An applicant shall provide the following
supplemental documents with an application submitted under subrule (1) of this
rule:
(a) The documents required under
section 11(2) of the act, MCL
550.821.
(b) A document providing the names,
addresses, dates of birth, social security numbers, official positions, and
professional qualifications of each individual who owns, legally or
beneficially, 10% or more of the equity in the entity that is applying for a
license.
(c) Each of the following:
(i) A list of every health plan or carrier on
behalf of which the pharmacy benefit manager contracts with a pharmacy or a
pharmacy services administration organization to provide pharmacy health
services to individuals covered by the health plan or carrier.
(ii) A statement indicating all jurisdictions
where the applicant has an application pending or has been registered,
licensed, or otherwise certified to transact business as a pharmacy benefit
manager.
(iii) A statement
indicating whether:
(A) The pharmacy benefit
manager or any individual responsible for the conduct of the affairs of the
pharmacy benefit manager has had a pharmacy benefit manager certificate of
authority or license denied or revoked for cause in another state.
(B) Any individual responsible for the
conduct of the affairs of the pharmacy benefit manager has been convicted of,
or has entered a plea of guilty or nolo contendere to, a felony without regard
to whether adjudication was withheld.
(C) The pharmacy benefit manager's license
has been suspended or revoked in another state.
(3) Any modification to the
information required under subrule (2)(b) and (c) of this rule is significant,
and, under section 11(3) of the act, MCL
550.821, the applicant shall file
with the director a notice of modification to any information within 30 days
after the modification.
Notes
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