When to File Application
A Medical Gas Dispenser is a facility that sells medical gases directly to patients in Delaware. However, if you are a facility that distributes medical gases to other facilities authorized to possess medical gases—instead of selling directly to patients—the correct application form is Application for Distributor (Pharmacy-Wholesale) .
File this application when applying for an initial license as a Medical Gas Dispenser OR re-applying when a previous Delaware license has lapsed and is no longer renewable. Since these licenses are not transferable, you must also file this application to report when a Medical Gas Dispenser already licensed in Delaware:
- Changes ownership (controlling interest), or
Requirements for All Applicants
- Submit completed, signed and notarized Application for Medical Gas Dispenser License.
- Enclose non-refundable processing fee by check or money order made payable to the “State of Delaware.”
- Enclose Medical Gas Dispenser Permit-Information about Ownership forms for all of the following:
- Designated Representative (DR) or most senior person responsible for facility operations, purchasing, and inventory control
- Supervisor of the DR or most senior person responsible for facility operations, purchasing and inventory control
- If the distributor is not a publicly held company, all principals and owners who directly or indirectly own more than 10% interest in the company
- Each person who is required to complete a Medical Gas Dispenser Permit-Information about Ownership form must also complete a Criminal History Record Check Authorization form to request State of Delaware and Federal Bureau of Investigation criminal background checks.
- Enclose one set (copy) of the plans for the dispenser facility.
- Plans must be drawn to scale and should show the area where medical gases will be dispensed, storage area, all entryways and security systems.
- Plans must also show the type of alarm system installed and the name, address, and phone of the provider.
In addition to meeting all the requirements above, medical gas dispenser facilities that are located in Delaware must be inspected before opening. A representative of the Delaware facility must notify the Board office when the facility is ready for inspection. When the facility passes the final inspection, the Board office will issue the license.
Reporting a Name Change
If the medical dispenser facility’s name changes but neither ownership nor location has changed , it is not necessary to submit an Application for Medical Gas Dispenser License. Instead, submit:
- Letter notifying the Board of the change that includes the dispenser’s old name, new name, license number and effective date of change.
- Duplicate license fee by check or money order made payable to the “State of Delaware.”
The duplicate license will show the new name, but the license number will not change.