Thank you for your interest in Value Drug Company. Please complete and submit the form below and a Value Drug Regional Account Manager will follow up with you shortly.
Pharmacy Name*
First Name*
Last Name*
Street Address*
City*
State*
Zip*
Phone Number*
Email*
Current Primary Wholesaler* AmerisourceBergenCapital WholesaleCardinal HealthH.D. SmithMcKessonMiami LukenPrescription SupplyRochester Drug CooperativeSmith DrugOther
Class of Trade* (Select multiple if appropriate.) 340B Entity/PharmacyDMESpecialty PharmacyLong Term CareRetail
New Start-Up?* YesNo
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