California
Statewide
Department Of Health And Human Services
Food And Drug
Last updated: 5/9/2022
Home Medical Device Retailer License Application {CDPH 8679}
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Description
CDPH 8679, HOME MEDICAL DEVICE RETAILER LICENSE APPLICATION, A separate application is required for each place of business. Please complete and/or amend this application as is most appropriate to your facility. Include the appropriate fee for each application as indicated in the fee schedule and payable to: CA DEPARTMENT OF PUBLIC HEALTH. This fee must accompany this application. Without the fee the application cannot be processed. Unsigned or incomplete applications cannot be processed. The following are further instructions on how to complete this application: Do not leave any sections blank. www.FormsWorkflow.com
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