[Federal Register Volume 88, Number 211 (Thursday, November 2, 2023)]
[Notices]
[Pages 75326-75330]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-24150]
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DEPARTMENT OF JUSTICE
Drug Enforcement Administration
Blue Mint Pharmacy; Decision and Order
On July 26, 2022, the Drug Enforcement Administration (DEA or
Government) issued an Order to Show Cause and Immediate Suspension of
Registration (OSC/ISO) to Blue Mint Pharmacy (Registrant) of Houston,
Texas. Request for Final Agency Action (RFAA), Government Exhibit
(RFAAX) 2, at 1. The OSC/ISO informed Registrant of the immediate
suspension of its DEA Certificate of Registration (registration),
Control No. FB4121327, pursuant to 21 U.S.C. 824(d), alleging that
Registrant's continued registration constitutes ```an imminent danger
to the public health or safety.''' Id. The OSC/ISO also proposed the
revocation of Registrant's registration, alleging that Registrant's
continued registration is inconsistent with the public interest. Id.
(citing 21 U.S.C. 824(a)(4), 823(g)(1)) \1\.
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\1\ Effective December 2, 2022, the Medical Marijuana and
Cannabidiol Research Expansion Act, Public Law 117-215, 136 Stat.
2257 (2022) (Marijuana Research Amendments or MRA), amended the
Controlled Substances Act (CSA) and other statutes. Relevant to this
matter, the MRA redesignated 21 U.S.C. 823(f), cited in the OSC/ISO,
as 21 U.S.C. 823(g)(1). Accordingly, this Decision cites to the
current designation, 21 U.S.C. 823(g)(1), and to the MRA-amended CSA
throughout.
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[[Page 75327]]
The Agency makes the following findings of fact based on the
uncontroverted evidence submitted by the Government in its RFAA dated
April 17, 2023.\2\
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\2\ Based on the Declaration from a DEA Diversion Investigator,
the Agency finds that the Government's service of the OSC/ISO on
Registrant was adequate. RFAAX 3, at 5. Further, based on the
Government's assertions in its RFAA, the Agency finds that more than
thirty days have passed since Registrant was served with the OSC/ISO
and Registrant has neither requested a hearing nor submitted a
corrective action plan and, therefore, has waived any such rights.
RFAA, at 2; see also 21 CFR 1301.43 and 21 U.S.C. 824(c)(2).
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I. Findings of Fact
Texas Standard of Care
DEA consulted Ms. Katherine Salinas, RPh, as an expert regarding
the standard of care in the state of Texas for pharmacy practice.\3\
RFAAX 4, at 1. According to Ms. Salinas, the Texas standard of care
requires that when dispensing a controlled substance, Texas pharmacists
must ensure that the prescription for the controlled substance is
valid, pursuant to a valid patient-practitioner relationship, and
issued for a legitimate medical purpose by an individual practitioner
acting in the usual course of his professional practice. Id. at 1-2.
Further, prior to dispensing a controlled substance, a pharmacist must
resolve any questions regarding the prescription with the prescriber
and maintain written documentation of any such discussions. Id. at 2. A
pharmacist must also review the patient's medication record and ``at a
minimum identify clinically significant: . . . (III) reasonable dose
and route of administration; . . . (IV) drug-drug interactions; . . .
and (X) proper utilization, including overutilization or
underutilization.'' Id.; see also 22 Tex. Admin. Code section
291.33(c)(2)(A)(i). According to Ms. Salinas, ``[a]ll [s]tate of Texas
pharmacists have access to these requirements[ ] and are required to
pass a jurisprudence examination in order to become a licensed
pharmacist.'' RFAAX 4, at 2. Further, ``[a]ll [s]tate of Texas
pharmacists know [that they are] required to exercise reasonable
caution in practice to prevent diversion by following common sense and
proper dispensing practices.'' Id. at 3.
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\3\ For Ms. Salinas' qualifications, see RFAAX 4, Attachment P.
Ms. Salinas is currently employed by the Texas State Board of
Pharmacy as a Compliance Officer, and one of her duties is to
inspect all classes of pharmacies for compliance with Texas pharmacy
rules and regulations. RFAAX 4, at 1.
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In particular, Ms. Salinas noted the Texas State Board of Pharmacy
``Red Flag Checklist,'' which is available to all Texas pharmacists on
the Texas State Board of Pharmacy's website and also provided during
pharmacy compliance inspections. Id. The red flags listed on the
checklist include pattern prescribing; \4\ prescriptions for controlled
substances commonly known to be abused such as opioids or muscle
relaxants; prescriptions for controlled substances at the highest
strength and/or in large quantities; \5\ patients obtaining similar
controlled substance prescriptions from multiple practitioners;
multiple patients sharing the same address and obtaining similar
controlled substance prescriptions from the same practitioner; and
patients consistently paying for controlled substance prescriptions
with cash rather than through insurance. Id. at 3-4. Ms. Salinas stated
that Texas pharmacists must document how they address and resolve any
red flags and must have prevention techniques in place to deter the
dispensing of fraudulent controlled substance prescriptions, such as
contacting doctors to verify prescriptions, searching the Texas Medical
Board website, talking with patients, and checking patient
identification cards. Id. at 4.
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\4\ Pattern prescribing is when `` `a pharmacy dispenses a
reasonably discernible pattern of substantially identical
prescriptions for the same controlled substances, potentially paired
with other controlled substances, for numerous persons, indicating a
lack of individual drug therapy in prescriptions issued by the
practitioner.' '' Id.
\5\ Such prescriptions can indicate a lack of individual drug
therapy in prescriptions issued by the practitioner. Id.
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Ms. Salinas concluded her explanation of the Texas standard of care
by stating that ``a pharmacist must engage in a verification process of
a prescription.'' Id. at 5. Further, Ms. Salinas stated: ``If a
pharmacist does not believe a prescription is for a legitimate medical
purpose, the pharmacist should not fill it.'' Id. Ms. Salinas also
noted that ``[a]s a Compliance Officer, when [she identifies] a
recurring pattern of certain combinations of controlled substances,
with the same dosage and in large quantities to various patients, being
paid for in cash instead of using insurance, [her] opinion is that the
pharmacy is inappropriately dispensing controlled substance
prescriptions and/or engaging in diversion activity.'' Id.
Expert Review of Registrant's Dispensing
Applying the Texas standard of care, Ms. Salinas reviewed
Registrant's PMP data from approximately February 1, 2021, through
March 31, 2022, Registrant's patient profiles for the fourteen patients
at issue, and copies of certain controlled substance prescriptions
issued to the fourteen patients. Id. Ultimately, Ms. Salinas concluded,
and the Agency agrees, that between February 1, 2021, and March 31,
2022, Registrant repeatedly filled prescriptions for controlled
substances for the fourteen patients at issue without addressing or
resolving red flags of abuse or diversion in violation of the Texas
standard of care and thus outside the usual course of professional
practice. Id. at 5-6, 18.
Patients A.W., M.F., and D.H.
Registrant filled nearly identical prescriptions for patients A.W.,
M.F., and D.H., who all shared an address. Specifically, between
January 31, 2022, and March 2, 2022, Registrant filled prescriptions
for Patient A.W. for 110 tablets of 10/325 mg hydrocodone/acetaminophen
and 85 tablets of 350 mg carisoprodol. RFAAX 4, at 6; see also RFAAX 3,
Attachment B. Further, between December 31, 2021, and March 15, 2022,
Registrant filled prescriptions for Patient M.F. for 120 tablets of 10/
325 mg hydrocodone/acetaminophen and 85 tablets of 350 mg carisoprodol.
RFAAX 4, at 11; see also RFAAX 3, Attachment H. Finally, between June
17, 2021, and August 26, 2021, Registrant filled prescriptions for
Patient D.H. for 110 tablets of 10/325 mg hydrocodone/acetaminophen and
90 tablets of 350 mg carisoprodol. RFAAX 4, at 14; see also RFAAX 3,
Attachment K.
In reviewing the prescriptions for these three individuals, Ms.
Salinas found that all of the prescriptions were issued by the same
practitioner, Dr. G.K., who prescribed the same controlled substances
in identical or substantially similar quantities to multiple patients;
both the hydrocodone/acetaminophen and the carisoprodol, controlled
substances known to be abused, were prescribed in large quantities and
at the highest dosage; the three patients shared the same address; and
all three patients paid cash for all of the prescriptions. RFAAX 4, at
6, 11-12, 14-15; see also RFAAX 3, Attachments B, H, K. Ms. Salinas did
not find any evidence that Registrant addressed these red flags of
abuse or diversion and, as a result, opined that Registrant violated
the minimum standard of care for a Texas pharmacy and operated outside
of the usual course of professional practice. RFAAX 4, at 6-7, 12, 15;
see also RFAAX 3, Attachments B, H, K.
[[Page 75328]]
Patient J.A., D.W., C.E, and S.F.
Registrant filled nearly identical prescriptions for patients J.A.,
D.W., C.E., and S.F, who all shared an address. Specifically, between
January 26, 2022, and March 25, 2022, Registrant filled prescriptions
for Patient J.A. for 110 tablets of 10/325 mg hydrocodone/acetaminophen
and 85 tablets of 350 mg carisoprodol. RFAAX 4, at 7; see also RFAAX 3,
Attachment C. Further, between January 18, 2022, and March 17, 2022,
Registrant filled prescriptions for Patient D.W. for 110 tablets of 10/
325 mg hydrocodone/acetaminophen and 85 tablets of 350 mg carisoprodol.
RFAAX 4, at 8; see also RFAAX 3, Attachment D. Between January 4, 2022,
and March 3, 2022, Registrant filled prescriptions for Patient C.E. for
110 tablets of 10/325 mg hydrocodone/acetaminophen and 85 tablets of
350 mg carisoprodol. RFAAX 4, at 10; see also RFAAX 3, Attachment G.
Finally, between December 30, 2021, and March 24, 2022, Registrant
filled prescriptions for Patient S.F. for 110 tablets of 10/325 mg
hydrocodone/acetaminophen and 90 tablets of 350 mg carisoprodol. RFAAX
4, at 12; see also RFAAX 3, Attachment I.
In reviewing the above prescriptions issued to the four patients,
Ms. Salinas found that all of the prescriptions were issued by the same
practitioner, Dr. G.K., who prescribed the same controlled substances
in identical or substantially similar quantities to multiple patients;
both the hydrocodone/acetaminophen and the carisoprodol, controlled
substances known to be abused, were prescribed in large quantities and
at the highest dosage; the four patients shared the same address and
three of the patients (J.A., D.W., and S.F.) shared the same phone
number; and all four patients paid cash for all of the prescriptions.
RFAAX 4, at 7-8, 10-11, 13; RFAAX 3, Attachments C, D, G, I. Ms.
Salinas did not find any evidence that Registrant addressed these red
flags of abuse or diversion and, as a result, opined that Registrant
violated the minimum standard of care for a Texas pharmacy and operated
outside of the usual course of professional practice. RFAAX 4, at 7-13;
see also RFAAX 3, Attachments C, D, G, I.
Patients A.B. and C.B.
Between January 17, 2022, and March 18, 2022, Registrant filled
prescriptions for both Patient A.B. and Patient C.B. for 120 tablets of
10/325 mg hydrocodone/acetaminophen and 90 tablets of 350 mg
carisoprodol. RFAAX 4, at 9-10; see also RFAAX 3, Attachment E, F. In
reviewing the prescriptions, Ms. Salinas found that all of the
prescriptions were issued by the same practitioner, Dr. G.K., who
prescribed the same controlled substances in identical or substantially
similar quantities to multiple patients; both the hydrocodone/
acetaminophen and the carisoprodol, controlled substances known to be
abused, were prescribed in large quantities and at the highest dosage;
and Patients A.B. and C.B. paid cash for all of the prescriptions. Id.
Ms. Salinas did not find any evidence that Registrant addressed these
red flags of abuse or diversion and, as a result, opined that
Registrant violated the minimum standard of care for a Texas pharmacy
and operated outside of the usual course of professional practice. Id.
Patient T.P.
Between July 8, 2021, and September 10, 2021, Registrant filled
prescriptions for Patient T.P. for 110 tablets of 10/325 mg
hydrocodone/acetaminophen and 85 tablets of 350 mg carisoprodol. RFAAX
4, at 13-14; see also RFAAX 3, Attachment J. In reviewing the
prescriptions, Ms. Salinas found that all of the prescriptions were
issued by the same practitioner, Dr. G.K., who prescribed the same
controlled substances in identical or substantially similar quantities
to multiple patients; both the hydrocodone/acetaminophen and the
carisoprodol, controlled substances known to be abused, were prescribed
in large quantities and at the highest dosage; Patient T.P. shared the
same phone number as Patient M.F.; and Patient T.P. paid cash for all
of the prescriptions. RFAAX 4, at 14; see also RFAAX 3, Attachment J.
Ms. Salinas did not find any evidence that Registrant addressed these
red flags of abuse or diversion and, as a result, opined that
Registrant violated the minimum standard of care for a Texas pharmacy
and operated outside of the usual course of professional practice.
RFAAX 4, at 14; see also RFAAX 3, Attachment J.
Patient G.A.
Between February 24, 2021, and February 9, 2022, Registrant filled
prescriptions for Patient G.A. for 120 tablets of 10/325 mg
hydrocodone/acetaminophen and 90 tablets of 350 mg carisoprodol. RFAAX
4, at 15; see also RFAAX 3, Attachment L. In reviewing the
prescriptions, Ms. Salinas found that the prescriptions were issued by
multiple, different practitioners. RFAAX 4, at 14-15; see also RFAAX 3,
Attachment L. Ms. Salinas did not find any evidence that Registrant
addressed this red flag of abuse or diversion and, as a result, opined
that Registrant violated the minimum standard of care for a Texas
pharmacy and operated outside of the usual course of professional
practice. RFAAX 4, at 16; see also RFAAX 3, Attachment L.
Patient K.G.
Between February 1, 2021, and March 15, 2022, Registrant filled
prescriptions for Patient K.G. for 110 tablets of 10/325 mg
hydrocodone/acetaminophen and 80 tablets of 350 mg carisoprodol. RFAAX
4, at 16; see also RFAAX 3, Attachment M. In reviewing the
prescriptions, Ms. Salinas found that the prescriptions were issued by
multiple, different practitioners. Id. Ms. Salinas did not find any
evidence that Registrant addressed this red flag of abuse or diversion
and, as a result, opined that Registrant violated the minimum standard
of care for a Texas pharmacy and operated outside of the usual course
of professional practice. Id.
Patient L.J.
Between March 12, 2021, and March 23, 2022, Registrant filled
prescriptions for Patient L.J. for 112 tablets of 10/325 mg
hydrocodone/acetaminophen and 80 tablets of 350 mg carisoprodol. RFAAX
4, at 17; see also RFAAX 3, Attachment N. In reviewing the
prescriptions, Ms. Salinas found that the prescriptions were issued by
multiple, different practitioners. Id. Ms. Salinas did not find any
evidence that Registrant addressed this red flag of abuse or diversion
and, as a result, opined that Registrant violated the minimum standard
of care for a Texas pharmacy and operated outside of the usual course
of professional practice. Id.
Patient T.T.
Between February 4, 2021, and March 8, 2022, Registrant filled
prescriptions for Patient T.T. for 110 tablets of 10/325 mg
hydrocodone/acetaminophen and 80 tablets of 350 mg carisoprodol. RFAAX
4, at 17; see also RFAAX 3, Attachment O. In reviewing the
prescriptions, Ms. Salinas found that the prescriptions were issued by
multiple, different practitioners. Id. Ms. Salinas did not find any
evidence that Registrant addressed this red flag of abuse or diversion
and, as a result, opined that Registrant violated the minimum standard
of care for a Texas pharmacy and operated outside of the usual course
of professional practice. RFAAX 4, at 17-18; see also RFAAX 3,
Attachment O.
II. Discussion
A. The Five Public Interest Factors
Under the CSA, ``[a] registration . . . to . . . dispense a
controlled substance
[[Page 75329]]
. . . may be suspended or revoked by the Attorney General upon a
finding that the registrant . . . has committed such acts as would
render [its] registration under section 823 of this title inconsistent
with the public interest as determined under such section.'' 21 U.S.C.
824(a). In making the public interest determination, the CSA requires
consideration of the following factors:
(A) The recommendation of the appropriate State licensing board
or professional disciplinary authority.
(B) The [registrant]'s experience in dispensing, or conducting
research with respect to controlled substances.
(C) The [registrant]'s conviction record under Federal or State
laws relating to the manufacture, distribution, or dispensing of
controlled substances.
(D) Compliance with applicable State, Federal, or local laws
relating to controlled substances.
(E) Such other conduct which may threaten the public health and
safety.
21 U.S.C. 823(g)(1)
The Agency considers these public interest factors in the
disjunctive. Robert A. Leslie, M.D., 68 FR 15227, 15230 (2003). Each
factor is weighed on a case-by-case basis. Morall v. Drug Enf't Admin.,
412 F.3d 165, 173-74 (D.C. Cir. 2005). Any one factor, or combination
of factors, may be decisive. David H. Gillis, M.D., 58 FR 37507, 37508
(1993).
While the Agency has considered all of the public interest factors
in 21 U.S.C. 823(g)(1),\6\ the Government's evidence in support of its
prima facie case for revocation of Registrant's registration is
confined to Factors B and D. See RFAA, at 23-29. Moreover, the
Government has the burden of proof in this proceeding. 21 CFR 1301.44.
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\6\ As to Factor A, the record contains no evidence of a
recommendation from any state licensing board or professional
disciplinary authority. 21 U.S.C. 823(g)(1)(A). Nonetheless, an
absence of such evidence ``does not weigh for or against a
determination as to whether continuation of the [Registrant's] DEA
certification is consistent with the public interest.'' Roni
Dreszer, M.D., 76 FR 19434, 19444 (2011). As to Factor C, there is
no evidence in the record that Registrant has been convicted of an
offense under either federal or state law ``relating to the
manufacture, distribution, or dispensing of controlled substances.''
21 U.S.C. 823(g)(1)(C). However, as Agency cases have noted, there
are a number of reasons why one who has engaged in criminal
misconduct may never have been convicted of an offense under this
factor. Dewey C. MacKay, M.D., 75 FR 49956, 49973 (2010). Agency
cases have therefore found that ``the absence of such a conviction
is of considerably less consequence in the public interest inquiry''
and is therefore not dispositive. Id. Finally, as to Factor E, the
Government's evidence fits squarely within the parameters of Factors
B and D and does not raise ``other conduct which may threaten the
public health and safety.'' 21 U.S.C. 823(g)(1)(E). Accordingly,
Factor E does not weigh for or against Registrant.
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Here, the Agency finds that the Government's evidence satisfies its
prima facie burden of showing that Registrant's continued registration
would be ``inconsistent with the public interest.'' 21 U.S.C.
824(a)(4).
B. Factors B and D
Evidence is considered under Public Interest Factors B and D when
it reflects compliance (or non-compliance) with laws related to
controlled substances and experience dispensing controlled substances.
See Sualeh Ashraf, M.D., 88 FR 1095, 1097 (2023); Kareem Hubbard, M.D.,
87 FR 21156, 21162 (2022). In the current matter, the Government has
alleged that Registrant violated numerous federal and state laws
regulating controlled substances. RFAAX 2, at 2.\7\ Specifically,
federal law requires that ``[a] prescription for a controlled substance
may only be filled by a pharmacist, acting in the usual course of his
professional practice,'' and that ``[a] prescription for a controlled
substance to be effective must be issued for a legitimate medical
purpose by an individual practitioner acting in the usual course of his
professional practice.'' 21 CFR 1306.04(a), 1306.06; see also 21 U.S.C.
829. Federal law also emphasizes that although ``[t]he responsibility
for the proper prescribing and dispensing of controlled substances is
upon the prescribing practitioner . . . a corresponding responsibility
rests with the pharmacist who fills the prescription.'' 21 CFR
1306.04(a).
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\7\ The Agency need not adjudicate the criminal violations
alleged in the instant OSC/ISO. Ruan v. United States, 142 S. Ct.
2,370 (2022) (decided in the context of criminal proceedings).
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As for state law, Texas regulations require that ``[a] pharmacist
may not . . . dispense or deliver a controlled substance . . . except
under a valid prescription and in the course of professional
practice.'' Tex. Health & Safety Code section 481.074(a)(1).\8\ The
Texas Board of Pharmacy sets forth numerous ``operational standards''
for pharmacists filling prescriptions, requiring, firstly, that
pharmacists ``review the patient's medication record. Such review shall
at a minimum identify clinically significant . . . (III) reasonable
dose and route of administration; . . . (VI) drug-drug interactions; .
. . and (X) proper utilization, including overutilization or
underutilization.'' 22 Tex. Admin. Code section 291.33(c)(2)(A)(i).
Further, ``[u]pon identifying any clinically significant conditions
[or] situations[,] . . . the pharmacist shall take appropriate steps to
avoid or resolve the problem including consultation with the
prescribing practitioner.'' Id. section 291.33(c)(2)(A)(ii). A
pharmacist must also ensure that ``[p]rior to dispensing, any questions
regarding a prescription drug order [ ] be resolved with the prescriber
and written documentation of these discussions [be] made and
maintained.'' Id. section 291.33(c)(2)(A)(iv). Finally, a pharmacist
must consider the various ``red flag factors'' in preventing the non-
therapeutic dispensing of controlled substances, including, among
others: pattern prescribing; prescriptions for controlled substances
commonly known to be abused; prescriptions for controlled substances at
the highest strength and/or in large quantities; patients obtaining
similar controlled substance prescriptions from multiple practitioners;
multiple patients sharing the same address and obtaining similar
controlled substance prescriptions from the same practitioner; and
patients consistently paying for controlled substance prescriptions
with cash rather than through insurance. Id. section 291.29(f).
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\8\ Texas law notes that ``[a] pharmacist may not . . . dispense
a controlled substance if the pharmacist knows or should have known
that the prescription was issued without a valid patient-
practitioner relationship.'' Id. section 481.074(a)(2). Further, it
is unlawful in Texas for any ``registrant or dispenser'' to
knowingly deliver a controlled substance in violation of sections
481.070-481.075 of the Texas Health and Safety Code. Id. section
481.128.
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Here, the record demonstrates that Registrant repeatedly filled
prescriptions for controlled substances for multiple patients without
adhering to Texas' ``operational standards'' for pharmacists filling
prescriptions and without addressing or resolving numerous and blatant
red flags of abuse and/or diversion. Because Registrant's conduct
clearly violates the Texas standard of care--thus rendering its
dispensing outside the usual course of professional practice--and
clearly violates the various federal and state regulations described
above, the Agency hereby sustains the Government's allegations that
Registrant repeatedly violated federal and state law relating to
controlled substances.
Accordingly, the Agency finds that Factors B and D weigh in favor
of revocation of Registrant's registration and thus finds Registrant's
continued registration to be inconsistent with the public interest in
balancing the factors of 21 U.S.C. 823(g)(1). The Agency further finds
that Registrant failed to provide sufficient evidence to rebut the
Government's prima facie case.
III. Sanction
Where, as here, the Government has established grounds to revoke
[[Page 75330]]
Registrant's registration, the burden shifts to the registrant to show
why it can be entrusted with the responsibility carried by a
registration. Garret Howard Smith, M.D., 83 FR 18882, 18910 (2018).
When a registrant has committed acts inconsistent with the public
interest, it must both accept responsibility and demonstrate that it
has undertaken corrective measures. Holiday CVS, L.L.C., dba CVS
Pharmacy Nos 219 and 5195, 77 FR 62316, 62339 (2012) (internal
quotations omitted). Trust is necessarily a fact-dependent
determination based on individual circumstances; therefore, the Agency
looks at factors such as the acceptance of responsibility, the
credibility of that acceptance as it relates to the probability of
repeat violations or behavior, the nature of the misconduct that forms
the basis for sanction, and the Agency's interest in deterring similar
acts. See, e.g., Robert Wayne Locklear, M.D., 86 FR 33738, 33746
(2021).
Here, Registrant did not request a hearing, submit a corrective
action plan, respond to the OSC/ISO, or otherwise avail itself of the
opportunity to refute the Government's case. As such, Registrant has
made no representations as to its future compliance with the CSA nor
made any demonstration that it can be entrusted with registration.
Moreover, the evidence presented by the Government clearly shows that
Registrant violated the CSA, further indicating that Registrant cannot
be entrusted. Accordingly, the Agency will order the revocation of
Registrant's registration.
Order
Pursuant to 28 CFR 0.100(b) and the authority vested in me by 21
U.S.C. 824(a), I hereby revoke DEA Certificate of Registration No.
FB4121327 issued to Blue Mint Pharmacy. Further, pursuant to 28 CFR
0.100(b) and the authority vested in me by 21 U.S.C. 823(g)(1), I
hereby deny any pending applications of Blue Mint Pharmacy, to renew or
modify this registration, as well as any other pending application of
Blue Mint Pharmacy, for additional registration in Texas. This Order is
effective December 4, 2023.
Signing Authority
This document of the Drug Enforcement Administration was signed on
October 25, 2023, by Administrator Anne Milgram. That document with the
original signature and date is maintained by DEA. For administrative
purposes only, and in compliance with requirements of the Office of the
Federal Register, the undersigned DEA Federal Register Liaison Officer
has been authorized to sign and submit the document in electronic
format for publication, as an official document of DEA. This
administrative process in no way alters the legal effect of this
document upon publication in the Federal Register.
Heather Achbach,
Federal Register Liaison Officer, Drug Enforcement Administration.
[FR Doc. 2023-24150 Filed 11-1-23; 8:45 am]
BILLING CODE 4410-09-P