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EXPLANATION-Matter enclosed in bold-faced brackets [thus] in this bill is not enacted
and is intended to be omitted in the law.
SECOND REGULAR SESSION
SENATE COMMITTEE SUBSTITUTE FOR
HOUSE BILL NO. 2146
103RD GENERAL ASSEMBLY
5669S.03C KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 96.192, 96.196, 195.417, 206.110, and 579.060, RSMo, and to enact in lieu
thereof seven new sections relating to health care providers, with penalty provisions.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 96.192, 96.196, 195.417, 206.110, and 1
579.060, RSMo, are repealed and seven new sections enacted in 2
lieu thereof, to be known as sections 96.192, 96.196, 195.417, 3
206.110, 206.158, 376.417, and 579.060, to read as follows:4
96.192. 1. The board of trustees of any hospital 1
authorized under subsection 2 of this section, and 2
established and organized under the provisions of sections 3
96.150 to 96.229, may invest up to [twenty-five] fifty 4
percent of [the hospital's] its funds not required for 5
immediate disbursement in obligations or for the operation 6
of the hospital [in any United States investment grade fixed 7
income funds or any diversified stock funds, or both] into: 8
(1) Any mutual funds that invest in stocks, bonds, or 9
real estate, or any combination thereof; 10
(2) Bonds that have: 11
(a) One of the five highest long-term ratings or the 12
highest short-term rating issued by a nationally recognized 13
rating agency; and 14
(b) A final maturity of ten years or less; 15
(3) Money-market investments; or 16
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(4) Any combination of investments described in 17
subdivisions (1) to (3) of this subsection. 18
The board shall invest the remaining percentage of funds not 19
required for immediate disbursement into any investment in 20
which the state treasurer is allowed to invest. 21
2. The provisions of this section shall only apply if 22
the hospital: 23
(1) Receives less than [one] three percent of its 24
annual revenues from municipal, county, or state taxes; and 25
(2) Receives less than [one] three percent of its 26
annual revenue from appropriated funds from the municipality 27
in which such hospital is located. 28
96.196. 1. A hospital organized under this chapter 1
may purchase, operate or lease, as lessor or lessee, related 2
facilities or engage in health care activities, except in 3
counties of the third or fourth classification (other than 4
the county in which the hospital is located) where there 5
already exists a hospital organized pursuant to this chapter 6
[and chapter 205 or 206]; provided, however, that this 7
exception shall not prohibit the continuation of existing 8
activities otherwise allowed by law. 9
2. If a hospital organized pursuant to this chapter 10
accepts appropriated funds from the city during the twelve 11
months immediately preceding the date that the hospital 12
purchases, operates or leases its first related facility 13
outside the city boundaries or engages in its first health 14
care activity outside the city boundaries, the governing 15
body of the city shall approve the hospital's plan for such 16
purchase, operation or lease prior to implementation of the 17
plan. 18
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195.417. 1. The limits specified in this section 1
shall not apply to any quantity of such product, mixture, or 2
preparation which must be dispensed, sold, or distributed in 3
a pharmacy pursuant to a valid prescription. 4
2. Within any thirty-day period, no person shall sell, 5
dispense, or otherwise provide to the same individual, and 6
no person shall purchase, receive, or otherwise acquire more 7
than the following amount: any number of packages of any 8
drug product containing any detectable amount of ephedrine, 9
phenylpropanolamine, or pseudoephedrine, or any of their 10
salts or optical isomers, or salts of optical isomers, 11
either as: 12
(1) The sole active ingredient; or 13
(2) One of the active ingredients of a combination 14
drug; or 15
(3) A combination of any of the products specified in 16
subdivisions (1) and (2) of this subsection; 17
in any total amount greater than seven and two-tenths grams, 18
without regard to the number of transactions. 19
3. Within any twenty-four-hour period, no pharmacist, 20
intern pharmacist, or registered pharmacy technician shall 21
sell, dispense, or otherwise provide to the same individual, 22
and no person shall purchase, receive, or otherwise acquire 23
more than the following amount: any number of packages of 24
any drug product containing any detectable amount of 25
ephedrine, phenylpropanolamine, or pseudoephedrine, or any 26
of their salts or optical isomers, or salts of optical 27
isomers, either as: 28
(1) The sole active ingredient; or 29
(2) One of the active ingredients of a combination 30
drug; or 31
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(3) A combination of any of the products specified in 32
subdivisions (1) and (2) of this subsection; 33
in any total amount greater than three and six-tenths grams 34
without regard to the number of transactions. 35
4. Within any twelve-month period, no person shall 36
sell, dispense, or otherwise provide to the same individual, 37
and no person shall purchase, receive, or otherwise acquire 38
more than the following amount: any number of packages of 39
any drug product containing any detectable amount of 40
ephedrine, phenylpropanolamine, or pseudoephedrine, or any 41
of their salts or optical isomers, or salts of optical 42
isomers, either as: 43
(1) The sole active ingredient; or 44
(2) One of the active ingredients of a combination 45
drug; or 46
(3) A combination of any of the products specified in 47
subdivisions (1) and (2) of this subsection; 48
in any total amount greater than [forty-three] sixty-one and 49
two-tenths grams, without regard to the number of 50
transactions. 51
5. All packages of any compound, mixture, or 52
preparation containing any detectable quantity of ephedrine, 53
phenylpropanolamine, or pseudoephedrine, or any of their 54
salts or optical isomers, or salts of optical isomers, 55
except those that are excluded from Schedule V in subsection 56
17 or 18 of section 195.017, shall be offered for sale only 57
from behind a pharmacy counter where the public is not 58
permitted, and only by a registered pharmacist or registered 59
pharmacy technician under section 195.017. 60
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6. Each pharmacy shall submit information regarding 61
sales of any compound, mixture, or preparation as specified 62
in this section in accordance with transmission methods and 63
frequency established by the department by regulation. 64
7. (1) As used in this subsection, "administrator of 65
the real-time electronic pseudoephedrine tracking system" 66
means the entity responsible for developing, implementing, 67
and maintaining the data collection system described in 19 68
CSR 30-1.074 or any successor regulation. 69
(2) Beginning October 1, 2026, and continuing 70
thereafter, any manufacturer of any compound, mixture, or 71
preparation specified in this section that is sold in or 72
into the state shall, on a monthly basis, pay fees to the 73
administrator of the real-time electronic pseudoephedrine 74
tracking system. 75
(3) The administrator of the real-time electronic 76
pseudoephedrine tracking system shall be responsible for 77
setting the fee levels required under this subsection. 78
(4) Upon the request of the department of health and 79
senior services, any manufacturer required to pay fees under 80
this subsection shall provide written documentation 81
demonstrating that the manufacturer has paid such fees. 82
(5) The fees required under this subsection shall be 83
assessed against each manufacturer solely on the basis of 84
sales transactions involving that manufacturer's own 85
compounds, mixtures, or preparations sold in or into the 86
state. No manufacturer shall be assessed fees based upon 87
transactions attributable to the compounds, mixtures, or 88
preparations of any other manufacturer. 89
8. No prescription shall be required for the 90
dispensation, sale, or distribution of any drug product 91
containing any detectable amount of ephedrine, 92
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phenylpropanolamine, or pseudoephedrine, or any of their 93
salts or optical isomers, or salts of optical isomers, in an 94
amount within the limits described in subsections 2, 3, and 95
4 of this section. The superintendent of the Missouri state 96
highway patrol shall report to the revisor of statutes and 97
the general assembly by February first when the statewide 98
number of methamphetamine laboratory seizure incidents 99
exceeds three hundred incidents in the previous calendar 100
year. The provisions of this subsection shall expire on 101
April first of the calendar year in which the revisor of 102
statutes receives such notification. 103
[8.] 9. This section shall supersede and preempt any 104
local ordinances or regulations, including any ordinances or 105
regulations enacted by any political subdivision of the 106
state. This section shall not apply to the sale of any 107
animal feed products containing ephedrine or any naturally 108
occurring or herbal ephedra or extract of ephedra. 109
[9.] 10. Any local ordinances or regulations enacted 110
by any political subdivision of the state prior to August 111
28, 2020, requiring a prescription for the dispensation, 112
sale, or distribution of any drug product containing any 113
detectable amount of ephedrine, phenylpropanolamine, or 114
pseudoephedrine, or any of their salts or optical isomers, 115
or salts of optical isomers, in an amount within the limits 116
described in subsections 2, 3, and 4 of this section shall 117
be void and of no effect and no such political subdivision 118
shall maintain or enforce such ordinance or regulation. 119
[10.] 11. All logs, records, documents, and electronic 120
information maintained for the dispensing of these products 121
shall be open for inspection and copying by municipal, 122
county, and state or federal law enforcement officers whose 123
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duty it is to enforce the controlled substances laws of this 124
state or the United States. 125
[11.] 12. All persons who dispense or offer for sale 126
pseudoephedrine and ephedrine products, except those that 127
are excluded from Schedule V in subsection 17 or 18 of 128
section 195.017, shall ensure that all such products are 129
located only behind a pharmacy counter where the public is 130
not permitted. 131
[12.] 13. The penalty for a knowing or reckless 132
violation of this section is found in section 579.060. 133
206.110. 1. A hospital district, both within and 1
outside such district, except in counties of the third or 2
fourth classification (other than within the district 3
boundaries) where there already exists a hospital organized 4
pursuant to [chapters 96, 205 or] this chapter; provided, 5
however, that this exception shall not prohibit the 6
continuation or expansion of existing activities otherwise 7
allowed by law, shall have and exercise the following 8
governmental powers, and all other powers incidental, 9
necessary, convenient or desirable to carry out and 10
effectuate the express powers: 11
(1) To establish and maintain a hospital or hospitals 12
and hospital facilities, and to construct, acquire, develop, 13
expand, extend and improve any such hospital or hospital 14
facility including medical office buildings to provide 15
offices for rental to physicians and dentists on the 16
district hospital's medical or dental staff, and the 17
providing of sites therefor, including offstreet parking 18
space for motor vehicles; 19
(2) To acquire land in fee simple, rights in land and 20
easements upon, over or across land and leasehold interest 21
in land and tangible and intangible personal property used 22
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or useful for the location, establishment, maintenance, 23
development, expansion, extension or improvement of any 24
hospital or hospital facility. The acquisition may be by 25
dedication, purchase, gift, agreement, lease, use or adverse 26
possession or by condemnation; 27
(3) To operate, maintain and manage a hospital and 28
hospital facilities, and to make and enter into contracts, 29
for the use, operation or management of a hospital or 30
hospital facilities; to engage in health care activities; 31
and to make and enter into leases of equipment and real 32
property, a hospital or hospital facilities, as lessor or 33
lessee, regardless of the duration of such lease; and to 34
provide rules and regulations for the operation, management 35
or use of a hospital or hospital facilities. Any agreement 36
entered into pursuant to this subsection pertaining to the 37
lease of the hospital shall have a definite termination date 38
as negotiated by the parties, but this shall not preclude 39
the trustees from entering into a renewal of the agreement 40
with the same or other parties pertaining to the same or 41
other subjects upon such terms and conditions as the parties 42
may agree; 43
(4) To fix, charge and collect reasonable fees and 44
compensation for the use or occupancy of the hospital or any 45
part thereof, or any hospital facility, and for nursing 46
care, medicine, attendance, or other services furnished by 47
the hospital or hospital facilities, according to the rules 48
and regulations prescribed by the board from time to time; 49
(5) To borrow money and to issue bonds, notes, 50
certificates, or other evidences of indebtedness for the 51
purpose of accomplishing any of its corporate purposes, 52
subject to compliance with any condition or limitation set 53
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forth in this chapter or otherwise provided by the 54
Constitution of the state of Missouri; 55
(6) To employ or enter into contracts for the 56
employment of any person, firm, or corporation, and for 57
professional services, necessary or desirable for the 58
accomplishment of the corporate objects of the district or 59
the proper administration, management, protection or control 60
of its property; 61
(7) To maintain the hospital for the benefit of the 62
inhabitants of the area comprising the district who are 63
sick, injured, or maimed regardless of race, creed or color, 64
and to adopt such reasonable rules and regulations as may be 65
necessary to render the use of the hospital of the greatest 66
benefit to the greatest number; to exclude from the use of 67
the hospital all persons who willfully disregard any of the 68
rules and regulations so established; to extend the 69
privileges and use of the hospital to persons residing 70
outside the area of the district upon such terms and 71
conditions as the board of directors prescribes by its rules 72
and regulations; 73
(8) To police its property and to exercise police 74
powers in respect thereto or in respect to the enforcement 75
of any rule or regulation provided by the ordinances of the 76
district and to employ and commission police officers and 77
other qualified persons to enforce the same; 78
(9) To lease to or allow for any institution of higher 79
education to use or occupy the hospital, any real estate or 80
facility owned or leased by the district or any part thereof 81
for the purpose of health care-related and general education 82
or training. 83
2. The use of any hospital or hospital facility of a 84
district shall be subject to the reasonable regulation and 85
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control of the district and upon such reasonable terms and 86
conditions as shall be established by its board of directors. 87
3. A regulatory ordinance of a district adopted under 88
any provision of this section may provide for a suspension 89
or revocation of any rights or privileges within the control 90
of the district for a violation of any such regulatory 91
ordinance. 92
4. Nothing in this section or in other provisions of 93
this chapter shall be construed to authorize the district or 94
board to establish or enforce any regulation or rule in 95
respect to hospitalization or the operation or maintenance 96
of such hospital or any hospital facilities within its 97
jurisdiction which is in conflict with any federal or state 98
law or regulation applicable to the same subject matter. 99
206.158. 1. The board of trustees of any hospital 1
authorized under subsection 2 of this section, and 2
established and organized under the provisions of sections 3
206.010 to 206.160, may invest up to fifty percent of its 4
funds not required for immediate disbursement in obligations 5
or for the operation of the hospital into: 6
(1) Any mutual funds that invest in stocks, bonds, or 7
real estate, or any combination thereof; 8
(2) Bonds that have: 9
(a) One of the five highest long-term ratings or the 10
highest short-term rating issued by a nationally recognized 11
rating agency; and 12
(b) A final maturity of ten years or less; 13
(3) Money-market investments; or 14
(4) Any combination of investments described in 15
subdivisions (1) to (3) of this subsection. 16
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The board shall invest the remaining percentage of funds not 17
required for immediate disbursement into any investment in 18
which the state treasurer is allowed to invest. 19
2. The provisions of this section shall only apply if 20
the hospital district receives less than three percent of 21
its annual revenues from hospital district or state taxes. 22
376.417. 1. As used in this section, the following 1
terms mean: 2
(1) "340B drug", the same meaning given to the term in 3
section 376.414; 4
(2) "Covered entity", any entity described in 5
subparagraphs (A) to (K) of subsection (a)(4) of Section 6
340B of the Public Health Service Act, 42 U.S.C. Section 7
256b, including any pharmacy with which such entity has 8
contracted to dispense 340B drugs on behalf of the entity; 9
(3) "Health carrier", the same meaning given to the 10
term in section 376.1350; 11
(4) "Pharmacy", an entity licensed under chapter 338; 12
(5) "Pharmacy benefits manager", the same meaning 13
given to the term in section 376.388. 14
2. A health carrier, a pharmacy benefits manager, or 15
an agent or affiliate of such health carrier or pharmacy 16
benefits manager shall not discriminate against a covered 17
entity including, but not limited to, by doing any of the 18
following: 19
(1) Reimbursing a covered entity for a quantity of a 20
340B drug in an amount less than it would pay any other 21
similarly situated pharmacy or entity that is not a covered 22
entity for such quantity of such drug on the basis that the 23
covered entity is a covered entity or that the covered 24
entity dispenses 340B drugs. The director of the department 25
of commerce and insurance shall specify by rule the 26
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circumstances under which a pharmacy or entity shall be 27
deemed a "similarly situated pharmacy or entity" for 28
purposes of this subdivision; 29
(2) Imposing any terms or conditions on covered 30
entities that differ from such terms or conditions applied 31
to other similarly situated entities or pharmacies that are 32
not covered entities on the basis that the covered entity is 33
a covered entity or that the covered entity dispenses 340B 34
drugs including, but not limited to, terms or conditions 35
with respect to any of the following: 36
(a) Fees, chargebacks, clawbacks, adjustments, or 37
other assessments; 38
(b) Professional dispensing fees; 39
(c) Restrictions or requirements regarding 40
participation in standard or preferred pharmacy networks; 41
(d) Requirements relating to the frequency or scope of 42
audits or to inventory management systems using generally 43
accepted accounting principles; and 44
(e) Any other restrictions, conditions, practices, or 45
policies that, as specified by the director of the 46
department of commerce and insurance, interfere with the 47
ability of a covered entity to maximize the value of 48
discounts provided under 42 U.S.C. Section 256b; 49
(3) Discriminating in reimbursement to a covered 50
entity based on the determination or indication a drug is a 51
340B drug; 52
(4) Requiring a covered entity to identify, either 53
directly or through a third party, a 340B drug; 54
(5) Refusing to cover drugs purchased under the 340B 55
drug-pricing program; or 56
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(6) Requiring a covered entity to reverse, resubmit, 57
or clarify a 340B drug-pricing claim after the initial 58
adjudication unless these actions are: 59
(a) In the normal course of pharmacy business and not 60
related to 340B drug pricing; or 61
(b) Required by federal law. 62
3. The director of the department of commerce and 63
insurance shall impose a civil penalty on any health 64
carrier, pharmacy benefits manager, or agent or affiliate of 65
such health carrier or pharmacy benefits manager that 66
violates the requirements of this section. Such penalty 67
shall not exceed five thousand dollars per violation per day. 68
4. The director of the department of commerce and 69
insurance shall promulgate rules to implement the provisions 70
of this section. Any rule or portion of a rule, as that 71
term is defined in section 536.010, that is created under 72
the authority delegated in this section shall become 73
effective only if it complies with and is subject to all of 74
the provisions of chapter 536 and, if applicable, section 75
536.028. This section and chapter 536 are nonseverable and 76
if any of the powers vested with the general assembly 77
pursuant to chapter 536 to review, to delay the effective 78
date, or to disapprove and annul a rule are subsequently 79
held unconstitutional, then the grant of rulemaking 80
authority and any rule proposed or adopted after August 28, 81
2026, shall be invalid and void. 82
579.060. 1. A person commits the offense of unlawful 1
sale, distribution, or purchase of over-the-counter 2
methamphetamine precursor drugs if he or she knowingly: 3
(1) Sells, distributes, dispenses, or otherwise 4
provides any number of packages of any drug product 5
containing detectable amounts of ephedrine, 6
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phenylpropanolamine, or pseudoephedrine, or any of their 7
salts, optical isomers, or salts of optical isomers, in a 8
total amount greater than seven and two-tenths grams to the 9
same individual within a thirty-day period, unless the 10
amount is dispensed, sold, or distributed pursuant to a 11
valid prescription; or 12
(2) Purchases, receives, or otherwise acquires within 13
a thirty-day period any number of packages of any drug 14
product containing any detectable amount of ephedrine, 15
phenylpropanolamine, or pseudoephedrine, or any of their 16
salts or optical isomers, or salts of optical isomers in a 17
total amount greater than seven and two-tenths grams, 18
without regard to the number of transactions, unless the 19
amount is purchased, received, or acquired pursuant to a 20
valid prescription; or 21
(3) Purchases, receives, or otherwise acquires within 22
a twenty-four-hour period any number of packages of any drug 23
product containing any detectable amount of ephedrine, 24
phenylpropanolamine, or pseudoephedrine, or any of their 25
salts or optical isomers, or salts of optical isomers in a 26
total amount greater than three and six-tenths grams, 27
without regard to the number of transactions, unless the 28
amount is purchased, received, or acquired pursuant to a 29
valid prescription; or 30
(4) Sells, distributes, dispenses, or otherwise 31
provides any number of packages of any drug product 32
containing detectable amounts of ephedrine, 33
phenylpropanolamine, or pseudoephedrine, or any of their 34
salts, optical isomers, or salts of optical isomers, in a 35
total amount greater than [forty-three] sixty-one and two- 36
tenths grams to the same individual within a twelve-month 37
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period, unless the amount is dispensed, sold, or distributed 38
pursuant to a valid prescription; or 39
(5) Purchases, receives, or otherwise acquires within 40
a twelve-month period any number of packages of any drug 41
product containing any detectable amount of ephedrine, 42
phenylpropanolamine, or pseudoephedrine, or any of their 43
salts or optical isomers, or salts of optical isomers in a 44
total amount greater than [forty-three] sixty-one and two- 45
tenths grams, without regard to the number of transactions, 46
unless the amount is purchased, received, or acquired 47
pursuant to a valid prescription; or 48
(6) Dispenses or offers drug products that are not 49
excluded from Schedule V in subsection 17 or 18 of section 50
195.017 and that contain detectable amounts of ephedrine, 51
phenylpropanolamine, or pseudoephedrine, or any of their 52
salts, optical isomers, or salts of optical isomers, without 53
ensuring that such products are located behind a pharmacy 54
counter where the public is not permitted and that such 55
products are dispensed by a registered pharmacist or 56
pharmacy technician under subsection 11 of section 195.017; 57
or 58
(7) Holds a retail sales license issued under chapter 59
144 and knowingly sells or dispenses packages that do not 60
conform to the packaging requirements of section 195.418. 61
2. A pharmacist, intern pharmacist, or registered 62
pharmacy technician commits the offense of unlawful sale, 63
distribution, or purchase of over-the-counter 64
methamphetamine precursor drugs if he or she knowingly: 65
(1) Sells, distributes, dispenses, or otherwise 66
provides any number of packages of any drug product 67
containing detectable amounts of ephedrine, 68
phenylpropanolamine, or pseudoephedrine, or any of their 69
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salts or optical isomers, or salts of optical isomers, in a 70
total amount greater than three and six-tenth grams to the 71
same individual within a twenty-four hour period, unless the 72
amount is dispensed, sold, or distributed pursuant to a 73
valid prescription; or 74
(2) Fails to submit information under subsection 13 of 75
section 195.017 and subsection 6 of section 195.417 about 76
the sales of any compound, mixture, or preparation of 77
products containing detectable amounts of ephedrine, 78
phenylpropanolamine, or pseudoephedrine, or any of their 79
salts, optical isomers, or salts of optical isomers, in 80
accordance with transmission methods and frequency 81
established by the department of health and senior services; 82
or 83
(3) Fails to implement and maintain an electronic log, 84
as required by subsection 12 of section 195.017, of each 85
transaction involving any detectable quantity of 86
pseudoephedrine, its salts, isomers, or salts of optical 87
isomers or ephedrine, its salts, optical isomers, or salts 88
of optical isomers; or 89
(4) Sells, distributes, dispenses or otherwise 90
provides to an individual under eighteen years of age 91
without a valid prescription any number of packages of any 92
drug product containing any detectable quantity of 93
pseudoephedrine, its salts, isomers, or salts of optical 94
isomers, or ephedrine, its salts or optical isomers, or 95
salts of optical isomers. 96
3. Any person who violates the packaging requirements 97
of section 195.418 and is considered the general owner or 98
operator of the outlet where ephedrine, pseudoephedrine, or 99
phenylpropanolamine products are available for sale shall 100
not be penalized if he or she documents that an employee 101
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training program was in place to provide the employee who 102
made the unlawful retail sale with information on the state 103
and federal regulations regarding ephedrine, 104
pseudoephedrine, or phenylpropanolamine. 105
4. A manufacturer commits the offense of unlawful 106
sale, distribution, or purchase of over-the-counter 107
methamphetamine precursor drugs if he or she knowingly fails 108
to pay the fees required under subsection 7 of section 109
195.417. 110
5. The offense of unlawful sale, distribution, or 111
purchase of over-the-counter methamphetamine precursor drugs 112
is a class A misdemeanor. 113
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