(a) the name and address of the licensee;
(b) the nature of the controlled substances, either by name or schedule, or both, which may be manufactured or distributed;
(c) whether manufacture or distribution or both such activities are permitted by the license. 5. Upon application of a licensee, a license may be amended to allow the licensee to relocate within the state or to add a manufacturing or distributing activity or to add further substances or schedules to the manufacturing or distribution activity permitted thereunder. The fee for such amendment shall be two hundred fifty dollars.