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The document is a surety bond agreement between a pharmaceutical drug facility and a surety company, ensuring compliance with the Mississippi Pharmacy Practice Act. It outlines the bond amount, conditions for claims, cancellation rights, and legal governance. The bond secures payment of administrative penalties and costs incurred by the Mississippi Board of Pharmacy.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Applicant’s/Principal’s name as it appears on the permit in the designated field.
Fill in the address for service of process, ensuring accuracy for legal correspondence.
Select the appropriate bond amount by checking either 'One Hundred Thousand Dollars' or 'Twenty-Five Thousand Dollars'.
Complete the Surety’s name and state of incorporation, followed by their service address.
Sign and print your name in the designated fields for both Principal’s Authorized Representative and Surety Company’s Representative.
Ensure all witness signatures are completed where indicated to validate the bond.

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