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(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.
R 500.34 License renewal schedule; license renewal fee.
Rule 4. (1) To renew an existing license for an additional 2 years, a pharmacy benefit
manager shall file the materials required under this rule and section 11(10) of the act, MCL
550.821, no later than July 1 of the second calendar year after the calendar year in which
the pharmacy benefit manager either first obtained or last renewed the existing license.
(2) A license expires if the pharmacy benefit manager fails to submit a complete renewal
filing by the date established in subrule (1) of this rule. If a license expires under this
subrule, the pharmacy benefit manager shall not operate in this state as a pharmacy benefit
manager without first obtaining a new license through the process in R 500.33. On request
and for good cause shown, the director may grant to a pharmacy benefit manager a
reasonable extension of time not to exceed 30 days within which the renewal materials
must be filed.
(3) A renewal filing is incomplete if the director determines that it does not contain a
completed application and renewal schedule and full payment of the nonrefundable license
renewal fee that is established by the director.
(4) A renewal application or a renewal schedule is not complete unless the licensee fully
and accurately provides all the information and materials requested on any form provided
by the director. The director has discretion to revise any form that the director provides
under this subdivision.
(5) The director may establish the amount of the nonrefundable license renewal fee by
bulletin. The director shall not adjust the license renewal fee more than once per year.