A. The licensee shall complete an application on a form approved by the appropriate Board and pay a fee in accordance with the fee schedule for:
(1) Physicians at COMAR 10.32.01.11;
(2) Podiatrists at COMAR 10.40.03; or
(3) Dentists at COMAR 10.44.20.
B. The application shall require the following information to indicate that the licensee is prescribing in the public interest:
(1) The name, address, and license number of the applicant;
(2) A certificate by the applicant that the applicant:
(a) Shall comply with the dispensing requirements set forth in Regulation .04 of this chapter; and
(b) Is thoroughly familiar with the statute and regulations which govern dispensing of prescription drugs set forth in Health Occupations Article, Title 12, Annotated Code of Maryland, and COMAR 10.34.
C. Each permit issued to a licensee expires 5 years after its date of issuance and is renewable upon timely submission of a renewal application in accordance with the requirements set forth in this regulation. The fee schedule set forth in §A of this regulation applies to all renewal applications.