Указ Губернатора Орловской области от 30.10.2012 № 441

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|  9.1.   | Сведения о новых адресах мест | 2. Аптечные организации:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|         | осуществления лицензируемого  | 2.1. Аптека готовых лекарственных форм                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         | вида деятельности.            | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         | Сведения о новых работах      | 2.2. Аптека производственная                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
|         | (услугах), которые лицензиат  | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | намерен выполнять при         |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         | осуществлении                 | 2.3. Аптека производственная с правом изготовления асептических лекарственных препаратов                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|         | фармацевтической деятельности | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | в сфере обращения             |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         | лекарственных средств для     | 2.4. Аптечный пункт                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | медицинского применения       |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               | 2.5. Аптечный киоск                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                                              (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                                              |
|         |                               | __* хранение лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* перевозка лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* изготовление лекарственных препаратов для медицинского применения.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 3. Структурные подразделения медицинских организаций:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 3.1. Аптека готовых лекарственных форм                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               | 3.2. Аптека производственная                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
|         |                               | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         |                               | 3.3. Аптека производственная с правом изготовления асептических лекарственных препаратов                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               |
|         |                               | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                                               (адрес места осуществления фармацевтической деятельности)                                                                                                                                                                                                                                                                                                |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 3.4. Аптечный пункт                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* перевозка лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* изготовление лекарственных препаратов для медицинского применения.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         |                               | 4. Обособленные подразделения медицинских организаций, расположенных в сельских поселениях, в которых отсутствуют аптечные организации:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
|         |                               | 4.1. Центр (отделение) общей врачебной (семейной) практики                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
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|         |                               | 4.2. Амбулатория                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 4.3. Фельдшерский пункт                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 4.4. Фельдшерско-акушерский пункт                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 5. Индивидуальные предприниматели                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      |
|         |                               |                                                                                                                                                                                                                                                                            ___________________________________ (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                            |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* перевозка лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* изготовление лекарственных препаратов для медицинского применения.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | 6. Иные организации, осуществляющие обращение лекарственных средств                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | ___________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               |                                                                                                                                                                                                                                                                                              (адрес места осуществления лицензируемого вида деятельности)                                                                                                                                                                                                                                                                                              |
|         |                               | __* хранение лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               | __* хранение лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     |
|         |                               | __* перевозка лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         |                               | __* перевозка лекарственных средств для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               | __* розничная торговля лекарственными препаратами для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         |
|         |                               | __* отпуск лекарственных препаратов для медицинского применения;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       |
|         |                               |      __* изготовление лекарственных препаратов для медицинского применения                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             |
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|  9.2.   | Сведения о наличии            | Реквизиты документов:_______________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
|         | документов, подтверждающих    | ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ |
|         | наличие у лицензиата на праве |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | собственности или на ином     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | законном основании            |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | необходимых для осуществления |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | фармацевтической деятельности |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | помещений, соответствующих    |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | установленным требованиям,    |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | права на которые              |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | зарегистрированы в Едином     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | государственном реестре прав  |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | на недвижимое имущество и     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | сделок с ним                  |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
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|  9.3.   | Сведения о наличии высшего    | Реквизиты документов о высшем или среднем фармацевтическом образовании и сертификатов специалистов:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | или среднего                  | _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________                                                                                                                                                                                                                                                      |
|         | фармацевтического образования |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | и сертификатов специалистов - |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | для работников, намеренных    |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | осуществлять фармацевтическую |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | деятельность в сфере          |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | обращения лекарственных       |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | средств для медицинского      |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | применения по указанному      |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | новому адресу                 |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|  9.4.   | Сведения о наличии            | Реквизиты санитарно-эпидемиологического заключения:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | санитарно-эпидемиологического | ____________________________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
|         | заключения о соответствии     |                                                                                                                                                                                                                                                                                                  (дата и N санитарно-эпидемиологического заключения,                                                                                                                                                                                                                                                                                                   |
|         | помещений по указанному       |                                                                                                                                                                                                                                                                                                                  N бланка заключения)                                                                                                                                                                                                                                                                                                                  |
|         | новому адресу требованиям     |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | санитарных правил, выданного  |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | в установленном порядке       |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         |                               |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|—————————|———————————————————————————————|————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————————|
|  9.5.   | Реквизиты документа,          | N платежного                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
|         | подтверждающего факт уплаты   | поручения __________________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           |
|         | государственной пошлины за    | Дата ______________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    |
|         | предоставление лицензии, либо | В размере __________                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
|         | иные сведения, подтверждающие |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |
|         | факт уплаты указанной         |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |