Application Status Query

Instructions: 

Please allow one hour after receipt of your status update email for the updates to be reflected in the online checklist.

Please verify the checklist information below, including your address. If your address has changed, please e-mail your application number, name, profession, along with your old and new address. The Credentialing department posts status information following receipt and review of application materials.

As of  :  NONE
Application#  :  423732
Name  :  EDGEPARK MEDICAL SUPPLIES INDEPENDENCE MEDICAL AND HHI ENTERPRISES INC
Profession  :  Wholesale Distributor of Prescription Drugs
Address  :  RANCHO CUCAMONGA, CA
Application Status  :  Withdrawn (Applicant Request)


Requirements Not Met:
Description Status Comments (Please note, not all requirements will include comments)
Application Fee Not Met
05-11-12- Per legal’s telephone conference with Atty Steve Eisenberg. Application will be put on hold until company submits letter indicating they will be distributing prescription drugs. At this time they are not distributing prescription drugs. 03-08-12 Legal left voicemail message for Cynthia Sackett regarding this issue. Please submit letter to with draw applcation. 02-27-12 sent new letter for legal review. 02-20-12 per legal, information provided does not meet requirements for a wholesale distributor of prescription drugs, Please provide letter withdrawing application or proof of how you meet the definition of a wholesale distributor under 450.01 (24). 02-10-12 sent for legal review to determine if licensure is required.
PAGE 1 - Applicable blanks completed Not Met
Type of License Not Met
Applicant Address of Distributor Facility Not Met
Owner Partners Corporate Officers, titles, etc Not Met
Type of ownership or operation of Applicants Business completed. Not Met
Verification of Licensure in Other States (if applicable) Not Met
Inspection Information completed and approved. Not Met
Surety bond form #2819 completed. Not Met
Designated Representative Form #2812 Completed. Not Met
Authorization for release of FBI information (#2687) Not Met
FBI fingerprint records check complete. Not Met
Affidavit of applicant, signed Not Met
Federal Identification Number Collection Not Met
Date application was sent for board approval. This date will appear in the note section once all required items have been met. Not Met

Requirements Met:
Description Status Comments (Please note, not all requirements will include comments)