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LTC Pharmacy, which has been under investigation by the North Carolina Board of Pharmacy, surrendered its operating permit last September, and International Pharmaceuticals was denied a permit renewal. The two businesses shared offices in a building in Durham, N.C., but had no actual pharmacy, according to the board.

The letter to Hoppe noted it appears International Pharmaceuticals has active wholesaler licenses in at least 23 other states.

Manufacturing lapses and production shutdowns for contamination and other serious problems are behind many of the shortages, and there’s no quick fix for those problems. Other reasons include increased demand for some drugs, companies ending production of some drugs with tiny profit margins, consolidation in the generic drug industry and limited supplies of some ingredients.

Yet some gray marketers _ who may not be licensed, authorized distributors _ have used the crisis to make money by cornering the market on drugs in short supply and then offering them to desperate hospital pharmacists and cancer clinics at outrageous markups.

Currently, there are 268 prescription drugs in short supply in the U.S. That includes 34 new shortages reported this year, 204 that began in 2010 or 2011 and remain unresolved, and others that have persisted even longer, according to Erin R. Fox, manager of the University of Utah Drug Information Service, which tracks national drug shortages.

A report based on a survey last summer said that hospitals forced to buy crucial drugs from wholesalers outside their normal distribution chain were being charged markups averaging 650 percent. In one case, a drug for dangerously high blood pressure, normally priced at $25.90 per dose, was being offered to hospitals for $1,200.

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Linda A. Johnson can be followed at http://twitter.com/LindaJ_onPharma