Updated as of July 2017
COMPOUNDING AND REPACKAGING PHARMACY AGREEMENT
COMPOUNDINGANDREPACKAGING PHARMACY AGREEMENT
THIS AGREEMENTmade effective as of
BETWEEN:
[1]
LicenseeOf#[2]
On BehalfOf
[3]
(the“CompoundingandRepackagingPharmacy”)
-and–
[4]
LicenseeOf#[5]
On BehalfOf
[6]
(the“CommunityPharmacy”)
WHEREAS:
Thelicenseeof theCommunityPharmacyholdsacommunitypharmacylicence;
The licensee of the Compounding and Repackaging Pharmacy holds a compoundingandrepackagingpharmacylicence;
PharmacistsandpharmacytechniciansemployedbytheCommunityPharmacy dispensedrugstopatientsoftheCommunity Pharmacyandrequiretheservices oftheCompounding andRepackagingPharmacytocompoundorrepackage drugs,orboth,sothatthepharmacistsandpharmacytechnicians atthe CommunityPharmacycandispensethosedrugstopatientsoftheCommunity Pharmacy;
The Compounding and Repackaging Pharmacy iswilling to compound or repackagedrugs,orboth,fortheCommunityPharmacy;
TheCommunityPharmacyandtheCompoundingandRepackagingPharmacy wish to enter into an agreement for the provision of compounding or repackagingservices,or both,bytheCompoundingandRepackagingPharmacy;
TheCommunityPharmacyandtheCompoundingandRepackagingPharmacy recognizethatunder theterms of thePharmacy andDrug Regulation,AR
240/2006thelicenseeoftheCompoundingandRepackagingPharmacymust
ensure thatthe Compounding and Repackaging Pharmacy only provides pharmacyservicestotheCommunity Pharmacyunderthetermsofawritten contractthatincludesthetermsrequired bytheCouncil oftheCollegeandisin theformrequiredbytheRegistrarof theCollege;
THEREFOREthe CommunityPharmacy and the Compounding and Repackaging
Pharmacymutuallycovenantandagreeasfollows:
1.DEFINITIONSANDINTERPRETATION
1.1InthisAgreement:
“Agreement”includestheSchedulestotheAgreementandanyamendment madeto thisAgreementor theSchedules;
“College” means theAlbertaCollegeofPharmacy;
“communitypharmacylicence”meansacommunity pharmacy license issued undersection5(1)(a)of the Pharmacy and Drug Act;
“compoundingandrepackagingpharmacylicence”meansacompoundingand repackaginglicenceissuedundersection5(1)(b) of the Pharmacy and Drug Act;
“controlledsubstance”hasthesamemeaningasacontrolledsubstanceinthe ControlledDrugsandSubstancesAct, S.C. 1996, c. 19 and includesany substancethatisprohibited,regulated,controlledortargetedunderaregulation madeorcontinuedunderthatAct;
“dispense” meanstoprovideadrugpursuant toaprescription;
“drug” means a substance or combination of substances referred to in section 31, 32, or 33 of the Pharmacy and Drug Act or defined as an emergency release drug, or a special access drug under the Pharmacy and Drug Act and any combination of such substance or substances with any other substance;
“HealthInformationAct”meanstheHealthInformationAct,R.S.A.2000,c.H-5;
“HealthProfessionsAct”meanstheHealthProfessionsAct,R.S.A.2000,c.H-7;
“pharmacist”meansanindividualwhois registered asaclinicalpharmacistunder theHealthProfessionsActasaregulatedmemberoftheCollegeandholdsa practice permitissuedunderthatAct;
“PharmacyandDrugAct”meansthePharmacyandDrugAct,R.S.A.2000,c.P-
13;
“prescription”meansadirectionbyapersonwhoisauthorized byanActofthe LegislatureofAlberta oranActoftheParliamentofCanada toprescribedrugs, directingthata drugbe dispensedtoorfor thepatientnamedin thedirection;
“PrivacyOfficer”meanstheprivacyofficerdesignated bytheCommunity Pharmacytodealwithallissues underthisAgreementinrelationtotheHealth InformationAct;
“Registrar”meanstheRegistrar oftheCollege;
“Services”meanstheservices as set outin Schedule“A”.
1.2Anyreferencetoastatute,regulation,bylaw, standard orotherlegislative instrumentisareferencetothatstatute,regulation,bylaw,standardorother legislativeinstrumentasamendedor replacedfromtimetotime.
1.3Thesingularincludesthepluralandviceversa.
1.4ThefollowingSchedulesformpartofthisAgreement:
Schedule “A” — DescriptionoftheServicesUnderThisAgreement;
Schedule “B”— GuaranteesofQualityof theIngredientsandof theProducts of
CompoundingandRepackaging.
1.5If thereisaconflictbetweenaScheduleandaprovisionin thebodyof this
Agreement,theprovisionin thebodyof this Agreementprevails.
2.SERVICES
2.1TheCompounding andRepackagingPharmacyshallprovidetheServicesin accordancewiththisAgreement.
2.2TheServicesshallbe providedunderthedirectionofthelicenseeof the
CompoundingandRepackagingPharmacy.
2.3WheretheServicesinvolvecompoundinga drug,theServicesshallbe provided by:
(a)apharmacistat theCompoundingandRepackagingPharmacy; (b)apharmacytechnicianpracticing
i.in accordancewiththepharmacytechnician’sscope of practice, and
ii.underthedirectionofaclinicalorcourtesypharmacistpracticingin theCompoundingandRepackagingPharmacyin accordancewiththe provisionsofsection21of the Pharmacists and Pharmacy Technicians Profession Regulation,AR
129/2006andStandard20of theStandardsofPractice for
PharmacistsandPharmacyTechnicians;or
(c)anindividualwho is
- employedbytheCompoundingandRepackagingPharmacy;
- acting with theconsentof andunderthedirectsupervisionofaclinicalor courtesy pharmacistpracticingintheCompoundingandRepackaging Pharmacy; and
- actinginaccordancewiththeprovisionsofsections22 and23of the Pharmacists and Pharmacy Technicians Profession Regulation,AR129/2006.
2.4NothinginthisAgreementallowstheCompoundingandRepackagingPharmacy tocompoundorrepackageadrugforor onbehalfof theCommunityPharmacy unlesstheCommunityPharmacy:
(a)holdsavalidprescriptionforapatientforthatdrug;or
(b)hasareasonableexpectationofreceivingavalidprescriptionforapatient for thatdrugin theimmediatefuture.
2.5Subject to article 2.6, nothinginthisAgreementallowstheCompoundingandRepackagingPharmacy tosell orprovideacontrolledsubstanceexceptonawrittenorderspecifyingthat anamountof thecontrolledsubstanceisrequiredforemergency purposes.
2.6If the Compounding and Repackaging Pharmacy is a licensed dealer under the Narcotic Control Regulations, C.R.C. 1040 (Canada) the Compounding and Repackaging Pharmacy may, subject to the terms and conditions of its licence under the Narcotics Control Regulations, sell or provide those narcotics specified in its licence to the Community Pharmacy
3.TERM ANDRENEWAL
3.1ThetermofthisAgreementisfrom to [7](the
“Term”).
3.2ThisAgreementmayberenewedforsuchperiodoftimeasthepartiesmay mutuallyagreeto inwriting.
4.TERMINATION
4.1ThisAgreementisautomaticallyterminatedif:
(a)thecommunitypharmacylicenceheldbythelicenseeof theCommunity
Pharmacyexpires,issuspended,iscancelledorisotherwiseterminated;
(b)thecompoundingandrepackaginglicenceheldbythelicenseeofthe CompoundingandRepackagingPharmacyexpires,issuspended,is cancelledor isotherwiseterminated;or
(c)anorderismadeagainsteitherparty,orthelicenseeortheproprietorof either party,byahearingtribunalconstitutedunderthe HealthProfessions Actor thePharmacyandDrugAct,orboth,thatprevents theServices beingprovidedbytheCompoundingandRepackagingPharmacyor being receivedbytheCommunityPharmacy.
4.2Despitearticle4.1(a),thisAgreementisnotautomaticallyterminatedif:
(a)acommunitypharmacylicencehasbeenissuedbytheCollegeto anew licenseefor theCommunityPharmacy andthenewlicenseehasaffirmed thisAgreementinwriting;or
(b)theCommunityPharmacyisbeingoperated underthepersonal management,control anddirectionof anotherpharmacistin accordance with the terms of permissiongrantedto theproprietorbytheRegistrar undersection14(2)of thePharmacyandDrugActandthatpharmacist hasaffirmedthisAgreementinwriting.
4.3Despitearticle4.1(b),thisAgreementisnotautomaticallyterminatedif:
(a)acompoundingandrepackaginglicencehasbeenissuedbytheCollegeto anew licenseefor theCompoundingandRepackagingPharmacyandthe newlicenseehasaffirmedthisAgreementinwriting;or
(b)theCompoundingandRepackagingPharmacyisbeingoperatedunderthe personalmanagement,controlanddirectionof anotherpharmacistin accordancewiththe terms of permissiongrantedto theproprietorby the Registrarundersection14(2)of the PharmacyandDrugActand that pharmacisthasaffirmedthisAgreementinwriting.
4.4ExceptasotherwiseprovidedinthisAgreement,ifeitherpartyfailstoperform orobserveanycovenantcontainedinthisAgreement,thatpartymaygive writtennoticetotheotherpartydescribing ingeneraltermsthenatureofthe defaultandrequiringtheotherparty toremedythedefaultwithin [8]days.
4.5Ifaparty,whohasreceivedanoticeunderarticle4.4,failstoremedy the defaultwithinthe timespecifiedinarticle4.4,theotherpartymaybyfurther writtennoticeterminatethe agreement.
4.6Thepartiesmay terminatethisAgreementbymutualagreementinwriting.
4.7ToensurethatthisAgreementremainsconsistentwithany newdirectionsof the Councilof theCollegemadeundersection19(a)(i)ofthePharmacyandDrug Regulation,AR240/2006after theeffectivedateofthisAgreement,theparties agreetorenegotiatethe terms of thisAgreementtocomplywiththosenew directionsandtomakethenecessary amendmentstothisAgreementin accordancewitharticles5.4and18.3within 30workingdaysoftheissuanceof anynew directions.
4.8If thepartiesareunabletoreachanagreement andmake thenecessary amendmentstothisAgreementunderarticle4.7,thisAgreementterminateson the31stworkingdayafterthosedirectionsareissued.
4.9For thepurposesof articles4.7and4.8,adirectionby theCouncilof theCollege isissuedwhenitispassedbytheCouncilandispostedonthewebsite of the College.
5.LICENCES
5.1ThroughouttheTermandanyrenewal,theCompounding andRepackaging Pharmacy shall ensurethat its operations are managed,controlled and supervisedbyalicenseewho:
(a)maintainsacompoundingandrepackaginglicencefortheCompounding andRepackagingPharmacy;and
(b)complieswiththerequirementsofandanyconditionsimposedonthe compoundingandrepackaginglicence.
5.2Throughout the Term and any renewal of it, the Community Pharmacy shall ensure that its operations are managed, controlled and supervised by a licensee who
(a)maintainsacommunitypharmacylicencefortheCommunityPharmacy; and
(b)complieswith therequirementsof andanyconditionsimposedon the communitypharmacylicence.
5.3Eachpartyshalldisclosetotheotherpartythe conditions,ifany,imposedona pharmacylicencereferredtoin this articleor anyconditionsimposedonthe operationof thepharmacy.
5.4Eachpartyshallensure thatifthereisanyproposedamendmentto this Agreement,thelicenseeisadvisedofitandapprovesit inwritingbefore it becomes effective.
6.COMPLIANCEWITH LEGISLATIVEREQUIREMENTS
6.1Eachpartywarrantsthatit,its licensee,its proprietor,itsemployeesandagents willcomplywithalllegislativerequirementsapplicabletotheprovisionof the ServicesunderthisAgreementorlegislativerestrictionsontheprovisionof the ServicesunderthisAgreementorinanywayrelatingto thisAgreement, includingbutnotlimitedto legislativerequirementsorlegislativerestrictions imposedunderthefollowing:
(a) theControlledDrugsandSubstancesAct,S.C.1996,c.19 andall regulationsmadeorcontinuedunderit;
(b)theFoodandDrugsAct,R.S.C.1985,c.F-27andallregulationsmade or continuedunderit;
(c)theHealthProfessionsActand allregulationsmadeorcontinued underit;
(d)theStandardsofPracticeforPharmacistsandPharmacyTechnicians
adoptedbythe College;
(e)theCodeofEthicsadoptedbytheCollege;
(f)theGovernmentOrganizationAct,R.S.A.2000,c.G-10,Schedule7.1 andallregulationsmadeorcontinuedunderit;
(g)thePharmacyandDrugActandallregulationsmadeorcontinued underit;
(h)theStandardsfortheOperationofLicensed Pharmaciesadoptedby theCollege;
(i)theHealthInformationActandallregulationsmadeorcontinuedunder it.
6.2 Neither partywill doanythingunderthisAgreementtofrustrate orlimitaccessto documentsorinformationwhichtheCollegemaylawfullyrequirebe producedby theparties,theirlicensees,theirproprietors,pharmacistsemployedbythepartiesor otherwiseengagedinrelationto the provisionof theServices.
7.HEALTHINFORMATIONACT
7.1TheCompoundingandRepackagingPharmacyrecognizesthatinrelationto the Servicesitisanaffiliateof theCommunityPharmacyforthepurposesof the HealthInformationAct.
7.2TheCompoundingandRepackagingPharmacyshallprovidetheServicesunder thisAgreementinamannerthat complieswith:
(a)theCompounding and RepackagingPharmacy’s responsibilitiesunder the
HealthInformationActasan affiliateoftheCommunityPharmacy;and
(b)thereasonablewrittenpoliciesof theCommunityPharmacyrespecting compliancewiththeHealthInformationActthathavebeenprovidedto theCompoundingandRepackagingPharmacyinrelationtohealth informationasdefinedintheHealthInformationAct.
7.3 TheCompoundingandRepackagingPharmacyshallhaveasysteminplacefor ensuringcompliancewiththeHealthInformationActthatissatisfactoryto the CommunityPharmacy,actingreasonably.
7.4TheCompoundingandRepackagingPharmacyshallprovideadescriptionofthe systemreferredtoin article7.3totheCommunityPharmacy,respondto reasonablequestionsaboutthesystemfromtheCommunityPharmacyandallow theCommunityPharmacyto auditcompliancewiththesystem,acting
reasonably.
7.5WhereabreachoftheHealthInformationActoccursin theprovisionof the Servicesorotherwiseinrelationto thisAgreement as resultof an actionor omissionby theCompoundingandRepackagingPharmacy,itslicensee, proprietor,agents oremployees,theCompoundingandRepackagingPharmacy shall:
(a)promptlytake thestepsnecessary tominimizetheimpactof thebreach andtopreventare-occurrence;
(b)immediatelyadvisethePrivacy Officerof the occurrenceandthenatureof theoccurrence;
(c)cooperatewithandassisttheCommunityPharmacywithanyeffortsitis requiredtotake tomitigatetheimpactofthebreachontheindividuals affectedbythebreach;
(d)investigatethecauseof thebreachanddocumentthefindings; (e)reportthefindingsoftheinvestigationto thePrivacy Officer;
(f)developaremedialplan,if required,andprovideacopy to thePrivacy
Officer;
(g)reviewthefindingsof theinvestigationandthe remedialplan,ifany,with thePrivacy Officerand answerquestionsorreceivecommentsfromthe Privacy Officer abouteither of them;
(h)implementtheremedialplan,ifany;and
(i)allowtheCommunityPharmacy,actingreasonably,to verify andauditthe implementationof the remedialplan.
7.6InaccessingtheServicesunderthisAgreementandinundertakinganyotheract underthisAgreement,theCommunityPharmacyshallensure thatit,its licensee, proprietor,employeesandagentscomplywith theHealthInformationAct.
8.RECORDSTOBE KEPT SEPARATE
8.1If theCompoundingandRepackagingPharmacyoperatesasacommunity pharmacyunderacommunitypharmacylicence,theCompoundingand RepackingPharmacyshallkeep therecordsrelatingto its operationsasa communitypharmacyseparateanddistinctfromtherecordsrelatingto the ServicesitprovidesunderthisAgreement.
9.ACCESSTORECORDS
9.1TheCompoundingandRepackagingPharmacyshall,onreasonablenotice in writingfrom theCommunityPharmacy:
(a)providetheCommunityPharmacywithaccesstoanyrecords relatingto theprovisionof theServicesunderthisAgreement;and
(b)providetheCommunityPharmacywitha truecopyofanyrecords relating totheprovisionof the ServicesunderthisAgreement.
9.2TheCompoundingandRepackagingPharmacymaychargeareasonablefee for copyingrecords requiredtobeprovidedunderarticle9.1(b).
10.ACCESSTO INFORMATIONABOUTINGREDIENTS
10.1TheCompoundingandRepackagingPharmacyshallprovidetheCommunity Pharmacywiththefollowinginformationabouteach drugthatiscompoundedor repackagedunder thisAgreement:
(a)alistoftheingredients;
(b)thestrength ofeachingredient;and
(c)thequantityofeachingredient.
11.EMERGENCY CONTACT
11.1Eachpartyshallensurethat anappropriateindividualemployedbythepartyis readilyavailableat alltimestodeal withanyemergencyinrelationtothe Servicesorarisingout of theServices thatplaceslifeorhealthatrisk.
11.2For thepurposesof article11.1,theCompoundingandRepackagingPharmacy shallhaveasysteminplacetoensurethatfor24hoursaday,seven daysa week,thereisapharmacistavailableandreadilyaccessible,whohasaccessto thenecessaryinformationabout anydrugscompoundedorrepackagedaspart of theServices.
12.TRANSPORTATIONANDSTORAGE
12.1InprovidingtheServices,theCompoundingandRepackagingPharmacyshall use appropriatemethodsofstoring,packagingandtransportingdrugstoensure thesecurity andintegrity of thedrugs.
12.2TheCompoundingandRepackagingPharmacyshalltake appropriatesteps requiredtoensurethesecurity andconfidentialityofanypersonalorhealth informationaccompanyingdrugsduringstorageandtransport.
13.DISPENSING
13.1TheCompoundingandRepackagingPharmacyagreesandacknowledgesthatits pharmacistsorpharmacytechniciansshallnot dispenseanydrugcompoundedor repackagedaspartoftheServices toanypatientof theCommunityPharmacy.
13.2TheCompoundingandRepackagingPharmacyshallsendanydrugcompounded or repackagedaspartof theServices totheCommunityPharmacyfordispensing tothepatientsoftheCommunityPharmacy bypharmacistsor pharmacy techniciansat theCommunityPharmacy.
13.3Pharmacistsor pharmacytechniciansat theCommunityPharmacyare
responsiblefordispensinganydrugsprovidedto theCommunityPharmacyunder thisAgreementtothe patientsoftheCommunityPharmacy.
14.INSPECTIONOFPHARMACY
14.1Uponreasonablenoticebeingprovidedbythe CommunityPharmacy,the CompoundingandRepackagingPharmacyshallallowthe licenseeof the CommunityPharmacytoinspecttheCompoundingandRepackagingPharmacy’s facilitiesusedinrelationtotheprovisionof theServices.
14.2Subjectto article10.1,theCompoundingandRepackagingPharmacymay imposereasonableconfidentialityrequirementsinrelationtoobservationsmade andinformationreceivedduringaninspectionunderarticle14.1.
15.QUALITYOFWORKANDPRODUCT
15.1TheCompoundingandRepackagingPharmacyshalluse appropriateand acceptedprocesses incarryingoutthecompoundingandrepackagingactivities includedwithin theServices.
15.2TheCompoundingandRepackagingPharmacyguaranteesthequalityof productsusedinthecompoundingorrepackagingofanydrugunderthis Agreement inaccordancewithSchedule“B”.
15.3TheCompoundingandRepackagingPharmacyguaranteesthequalityofall drugs compoundedor repackaged,orboth,underthisAgreementinaccordance withSchedule“B”.
16.COMMUNITYPHARMACY’SOBLIGATION
16.1InanyrequestforServicesunderthisAgreement,theCommunityPharmacy, throughits licensee,shallensurethatits pharmacistsdonotrefer a prescription totheCompoundingandRepackagingPharmacyforthepurposesof obtaining theServices unlessits pharmacistshavetakenreasonablesteps toensurethat theprescriptionis:
(a)valid;and
(b)current,accurate,completeandappropriate.
16.2TheCommunityPharmacyshall,throughitslicensee,ensurethatitspharmacists andpharmacytechniciansdispenseanydrugsthatare compoundedor repackagedbytheCompoundingandRepackagingPharmacyunderthisAgreement to theCommunityPharmacy’s patientsinaccordancewiththeStandardsof Practicefor PharmacistsandPharmacyTechnicians.
16.3Withoutlimitingthegeneralityofarticle16.2,theCommunityPharmacyshall, throughits licensee,ensurethatits pharmacistswillbe responsiblefor allpatient interactionandareresponsibletoensurethe appropriatenessof thedrug therapy.
17.PROVISIONOFCONTRACTTOREGISTRAR
17.1Thepartieseach acknowledgethattheRegistrar of theCollegeisentitledto requestacopyof this Agreementfromeitherof themand thatuponreceiptof sucharequest thatpartyis requiredtoprovideacopyto theRegistrar.
18.GENERAL
18.1Subjectto article18.2thisAgreementcontainstheentire understanding
between thepartiesrelatingto thesubjectmattercontainedinit andsupersedes allprior oral andwrittenunderstandings,arrangementsandagreementsrelating tothesubjectmattercontainedinit.
18.2ThisAgreementis designedto addresstheregulatoryrequirements undersection
19(a)of thePharmacyandDrugRegulationandisnotdesignedtoaddressthe commercialrelationshipbetweentheparties,whichmaybegovernedbya
commercialagreementthatis
(a)notinconsistentwith thisAgreement;and
(b)availableto theRegistrarto ensurecompliancewithclause(a).
18.3Anyamendmentto thisAgreementmustbeinwritingandsignedby both parties.
18.4Anyvariation,alterationorwaiverofanyoftherightsorobligationsof the partiesunderthisAgreementmustbeinwritingandsignedbytheparties.
18.5EachoftheprovisionscontainedinthisAgreementis distinct andseverableand nowaiverofanyprovisionof thisAgreementshallconstituteawaiverof any otherprovisionnorshallanywaiverof anyprovisionof thisAgreement constitute acontinuingwaiverunlessotherwiseexpresslyprovided.
18.6Neither partymay assignthisAgreementoranyportionofit.
18.7ThisAgreementshallbeinterpretedinaccordancewithandisgovernedbythe lawsof theProvince ofAlberta.
18.8Thefollowingprovisionssurvive terminationof thisAgreement:articles6,7,8,
9,10,11,and15.
18.9Eachpartywarrantsthatthelicenseeofitspharmacyis authorizedtosignthis
Agreementonits behalf.
18.10ThisAgreementshallenuretobe thebenefitof andbe bindingupontheparties heretoandtheirrespectivepersonalrepresentatives,executors,administrators, successors andpermittedassigns.
18.11ThisAgreementappliesonlytotheprovisionofServicesin theProvince of
Alberta.
19.REVIEWOF AGREEMENTONOR BEFORE THE THIRD ANNIVERSARY
19.1Intheevent thattheTermof thisAgreementunderarticle3isgreaterthan3 years,thepartiesagreethattheyshallmeettoreviewthisAgreementonor before the thirdanniversaryof thedatetheAgreementismade effectiveto ensure thatthe terms of theAgreementare current andrelevant.
19.2Thepartiesshall:
(a)keepminutesof themeetingreferredtoinarticle19.1;
(b)ensurethattheminutesaresignedbythelicenseeofeach party; (c)provideacopyoftheminutestotheRegistraronrequest.
WHEREFORETHEPARTIEStothisAgreementhavedulyexecutedthisAgreementto be effective as of thedatewrittenabove.
COMPOUNDINGAND REPACKAGINGPHARMACY>
Per:
NAMEoflicensee
COMMUNITYPHARMACY>
Per:
NAMEof licensee
SCHEDULE “A”
DESCRIPTIONOFTHE SERVICESUNDERTHIS AGREEMENT
TheCompoundingandRepackagingPharmacyshallprovidetheServicestothe
CommunityPharmacy,whichshallinclude,butarenotlimitedto,thefollowing:
<To beinsertedbytheparties
SCHEDULE “B”
GUARANTEESOFQUALITYOFTHE INGREDIENTSANDOFTHE PRODUCTSOFCOMPOUNDINGANDREPACKAGING
<To beinsertedbytheparties
[1]Insert the name of the licensee of theCompoundingand RepackagingPharmacyhere.
[2]Insert thename of theCompoundingand RepackagingPharmacyand its licencenumberhere.
[3]Insert thelegal name oftheowner of theCompoundingand Repackaging Pharmacyhere.
[4]Insert thename of licenseeof theCommunityPharmacyhere.
[5]Insert thename of theCommunityPharmacyandits licencenumber here.
[6]Insert thelegal name oftheowner of theCommunityPharmacyhere.
[7]Insertthebeginningandend datesofthetermoftheAgreement.
[8]Insertthenumberofdaysthe partiesagreeupon.