New Hampshire Code of Administrative Rules
Ph - N.H. Pharmacy Board
Chapter Ph 600 - LIMITED RETAIL DRUG DISTRIBUTOR
Part Ph 601 - LICENSING OF LIMITED RETAIL DRUG DISTRIBUTORS
Section Ph 601.06 - Renewal Applications

(1) For medical gas suppliers, the online License Renewal Application available at https://nhlicenses.nh.gov/eGov/Login.aspx;

(2) For clinics under contract with DHHS, the online License Renewal Application, available at https://nhlicenses.nh.gov/eGov/Login.aspx; or

(3) For methadone maintenance/detoxification facilities, the online License Renewal Application, available at https://nhlicenses.nh.gov/eGov/Login.aspx.

(1) For medical gas suppliers:

(2) For methadone maintenance/detoxification facilities:

(1) For medical gas suppliers: "I affirm that I am the person authorized to sign this application for licensure on behalf of the company/licensee and affirm that this application (including any accompanying documents) has been examined by me and to the best of my knowledge and belief is a true, correct and complete application, and if the registration herein applied for is granted, I hereby agree to and do submit to the jurisdiction of the New Hampshire Board of Pharmacy and to the laws and rules of this State."

(2) For clinics under contract with DHHS: "I declare under penalties of unsworn falsification under RSA 641:3 that this application (including any accompanying documents) has been examined by me and to the best of my knowledge and belief is a true, correct and complete application, and if the permit herein applied for is granted, I hereby agree to and do submit to the jurisdiction of the New Hampshire Board of Pharmacy and to the laws and rules of this State."; and

(3) For methadone maintenance/detoxification facilities: "I declare under penalties of unsworn falsification under RSA 641:3 that this application (including any accompanying documents) has been examined by me and to the best of my knowledge and belief is a true, correct and complete application, and if the permit herein applied for is granted, I hereby agree to and do submit to the jurisdiction of the New Hampshire Board of Pharmacy and to the laws and rules of this State. To the best of my knowledge, myself nor any of the employees listed on this application, have been arrested, investigated for, charged with, convicted of, sentenced, entered a plea of non contendere, or entered into any other legal agreements for any criminal offense in any state, territory or possession of the United States or by the federal government."

(1) Files a complete application that meets the requirements of these rules and RSA 318; and

(2) Is of good moral character, or, if the applicant is an association or corporation, that the managing officers are of good moral character, as evidenced by the absence, within the last 5 years, of conviction of any felony, or of a misdemeanor resulting from a violation of any drug related law of the United States or of any state.