Applicant/Licensee facilities physically located in Louisiana only!

A CRIMINAL HISTORY RECORD is information collected by state and federal criminal justice agencies on persons consisting of identifiable description and notations of arrests, detentions, indictments, bills of information, or any formal criminal charges and any disposition arising there from. A criminal history record search in accordance with La. R.S. 37:3477 and LAC 46:XXXIV.305.B is required by the Board for all new applicants physically located in Louisiana to include the designated responsible party and any individual owners who owns greater than 10% interest in the applicant company; and for those licensees of previously issued licenses if a new DRP is appointed or if ownership interest of more than 10% has been transferred to a new owner. Conviction of a felony violation of federal or state law may be grounds for denial of or disciplinary action against a license as a distributor of legend drugs or devices.

APPLICATION FOR CRIMINAL HISTORY RECORDS SEARCH
Each qualified person must execute and submit the Board’s authorization statement below with regards to a licensure application, annual renewal, or information change request noted here:

I acknowledge I am aware of the LA Board of Drug and Device Distributors, Privacy Statement for Criminal History Records Checks which is available for my review on the Board’s website — Forms & Information page.

AUTHORIZATION FOR CRIMINAL HISTORY RECORDS SEARCH — Electronic Submission
By checking here and on the date below, the undersigned named individual hereby authorizes the Louisiana Board of Drug and Device Distributors to obtain criminal history records check information provided through the Louisiana Bureau of Criminal Identification and Information of the Office of State Police within the Louisiana Department of Public Safety and as provided by the Federal Bureau of Investigation.

Submission Date: 04/03/2025