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2018-12-20T16:44:18+00:00
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Corporate Name
*
Pharmacy Name (DBA)
*
Pharmacy DEA License Upload
*
Pharmacy DEA #
*
Pharmacy NPI #
*
Pharmacy NCPDP #
*
Ownership Type
*
Corporation
Partnership
LLC
Proprietorship
Primary Officer First Name
*
Primary Officer Last Name
*
Primary Officer Position
*
Officer First Name
Officer Last Name
Position
Address
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Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Fax
*
Primary Contact First Name
*
Primary Contact Last Name
*
Primary Contact Title
*
Primary Contact Email
*
Vendor Name
Please Select
Anda
Auburn Pharmaceutical
Bloodworth Wholesale
BluPax Pharma
Bonita Pharm
Capital Wholesale Drug Co.
D&D Wholesale Supply
GRX "Greenhill Trading Company"
H&H Wholesale
HealthSource Distributors
Hercules Pharmaceuticals Inc.
HyGen Pharmaceuticals
IntegralRx (Division of JM Smith)
JAMS Distribution Services, LLC
KeySource Medical, Inc.
Masters Pharmaceutical (MRX)
Mercer Medical LLC
National Apothecary Services
NDC Distributors LLC
Northeast Medical Exchange
NuMed
Oak Drugs, Inc.
Paragon Meds
Parmed Pharmaceuticals
Pharmsource, LLC
Prescription Supply, Inc.
ProficientRx
Quality Care Products
QK Healthcare Inc.
Quality Care Products (QCP)
Quest Pharmaceuticals, Inc.
Real Value Products
River City Pharma
Scripts Wholesale
South Pointe Wholesale
Smart-Fill
TOP RX
Account Number
Vendor Name
Please Select
Anda
Auburn Pharmaceutical
Bloodworth Wholesale
BluPax Pharma
Bonita Pharm
Capital Wholesale Drug Co.
D&D Wholesale Supply
GRX "Greenhill Trading Company"
H&H Wholesale
HealthSource Distributors
Hercules Pharmaceuticals Inc.
HyGen Pharmaceuticals
IntegralRx (Division of JM Smith)
JAMS Distribution Services, LLC
KeySource Medical, Inc.
Masters Pharmaceutical (MRX)
Mercer Medical LLC
National Apothecary Services
NDC Distributors LLC
Northeast Medical Exchange
NuMed
Oak Drugs, Inc.
Paragon Meds
Parmed Pharmaceuticals
Pharmsource, LLC
Prescription Supply, Inc.
ProficientRx
Quality Care Products
QK Healthcare Inc.
Quality Care Products (QCP)
Quest Pharmaceuticals, Inc.
Real Value Products
River City Pharma
Scripts Wholesale
South Pointe Wholesale
Smart-Fill
TOP RX
Account Number
Vendor Name
Please Select
Anda
Auburn Pharmaceutical
Bloodworth Wholesale
BluPax Pharma
Bonita Pharm
Capital Wholesale Drug Co.
D&D Wholesale Supply
GRX "Greenhill Trading Company"
H&H Wholesale
HealthSource Distributors
Hercules Pharmaceuticals Inc.
HyGen Pharmaceuticals
IntegralRx (Division of JM Smith)
JAMS Distribution Services, LLC
KeySource Medical, Inc.
Masters Pharmaceutical (MRX)
Mercer Medical LLC
National Apothecary Services
NDC Distributors LLC
Northeast Medical Exchange
NuMed
Oak Drugs, Inc.
Paragon Meds
Parmed Pharmaceuticals
Pharmsource, LLC
Prescription Supply, Inc.
ProficientRx
Quality Care Products
QK Healthcare Inc.
Quality Care Products (QCP)
Quest Pharmaceuticals, Inc.
Real Value Products
River City Pharma
Scripts Wholesale
South Pointe Wholesale
Smart-Fill
TOP RX
Account Number
Vendor Name
Please Select
Anda
Auburn Pharmaceutical
Bloodworth Wholesale
BluPax Pharma
Bonita Pharm
Capital Wholesale Drug Co.
D&D Wholesale Supply
GRX "Greenhill Trading Company"
H&H Wholesale
HealthSource Distributors
Hercules Pharmaceuticals Inc.
HyGen Pharmaceuticals
IntegralRx (Division of JM Smith)
JAMS Distribution Services, LLC
KeySource Medical, Inc.
Masters Pharmaceutical (MRX)
Mercer Medical LLC
National Apothecary Services
NDC Distributors LLC
Northeast Medical Exchange
NuMed
Oak Drugs, Inc.
Paragon Meds
Parmed Pharmaceuticals
Pharmsource, LLC
Prescription Supply, Inc.
ProficientRx
Quality Care Products
QK Healthcare Inc.
Quality Care Products (QCP)
Quest Pharmaceuticals, Inc.
Real Value Products
River City Pharma
Scripts Wholesale
South Pointe Wholesale
Smart-Fill
TOP RX
Account Number
Vendor Name
Please Select
Anda
Auburn Pharmaceutical
Bloodworth Wholesale
BluPax Pharma
Bonita Pharm
Capital Wholesale Drug Co.
D&D Wholesale Supply
GRX "Greenhill Trading Company"
H&H Wholesale
HealthSource Distributors
Hercules Pharmaceuticals Inc.
HyGen Pharmaceuticals
IntegralRx (Division of JM Smith)
JAMS Distribution Services, LLC
KeySource Medical, Inc.
Masters Pharmaceutical (MRX)
Mercer Medical LLC
National Apothecary Services
NDC Distributors LLC
Northeast Medical Exchange
NuMed
Oak Drugs, Inc.
Paragon Meds
Parmed Pharmaceuticals
Pharmsource, LLC
Prescription Supply, Inc.
ProficientRx
Quality Care Products
QK Healthcare Inc.
Quality Care Products (QCP)
Quest Pharmaceuticals, Inc.
Real Value Products
River City Pharma
Scripts Wholesale
South Pointe Wholesale
Smart-Fill
TOP RX
Account Number
Vendor Name
Please Select
Anda
Auburn Pharmaceutical
Bloodworth Wholesale
BluPax Pharma
Bonita Pharm
Capital Wholesale Drug Co.
D&D Wholesale Supply
GRX "Greenhill Trading Company"
H&H Wholesale
HealthSource Distributors
Hercules Pharmaceuticals Inc.
HyGen Pharmaceuticals
IntegralRx (Division of JM Smith)
JAMS Distribution Services, LLC
KeySource Medical, Inc.
Masters Pharmaceutical (MRX)
Mercer Medical LLC
National Apothecary Services
NDC Distributors LLC
Northeast Medical Exchange
NuMed
Oak Drugs, Inc.
Paragon Meds
Parmed Pharmaceuticals
Pharmsource, LLC
Prescription Supply, Inc.
ProficientRx
Quality Care Products
QK Healthcare Inc.
Quality Care Products (QCP)
Quest Pharmaceuticals, Inc.
Real Value Products
River City Pharma
Scripts Wholesale
South Pointe Wholesale
Smart-Fill
TOP RX
Account Number
Check additional vendors below (if needed)
Anda
Auburn Pharmaceutical
Bloodworth Wholesale
BluPax Pharma
Bonita Pharm
Capital Wholesale Drug Co.
D&D Wholesale Supply
GRX "Greenhill Trading Company"
H&H Wholesale
HealthSource Distributors
Hercules Pharmaceuticals Inc.
HyGen Pharmaceuticals
IntegralRx (Division of JM Smith)
JAMS Distribution Services, LLC
KeySource Medical, Inc.
Masters Pharmaceutical (MRX)
Mercer Medical LLC
National Apothecary Services
NDC Distributors LLC
Northeast Medical Exchange
NuMed
Oak Drugs, Inc.
Paragon Meds
Parmed Pharmaceuticals
Pharmsource, LLC
Prescription Supply, Inc.
ProficientRx
Quality Care Products
QK Healthcare Inc.
Quality Care Products (QCP)
Quest Pharmaceuticals, Inc.
Real Value Products
River City Pharma
Scripts Wholesale
South Pointe Wholesale
Smart-Fill
TOP RX
Check all that apply outside of what has been entered above but accounts numbers will be required.
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Have you read, and do you agree to the Terms & Conditions?
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