Store Name
Owner's Name
Store Address
City
State
Zip
Phone Number
Home Phone Number
Cell Phone Number
Email Address
Value Drug Account Number
Type of Location UrbanSuburbanRuralShopping CenterStand Alone BuildingClinic
Competitors (How many and what Kind, Chains, independents, distance from store)
Store Hours
Store Website
Square Footage (Front-end, Pharmacy and Storage Area)
Staff (Pharmacists, Techs, Other, Any Speciality Personal: Surgical Fitters, Etc.)
Property (Own or Lease)
If Lease, Term Remaining: (Years/Months)
Prescription Volume: (Weekly RX Count Volumen/Annual Dollar Volume)
Reason for Proposed Sale
Desired Timing
Best Method for Contacting You
We understand the sensitivity of the information you are providing. Feel rest assured that we're treating your information with the utmost caution and this information will only be shared with Value Drug Company's President, VP of Finance, and VP of Sales and Marketing.
Would you like to keep this information confidential? YesNo
Submit
