How many stores are you interested in selling?
Please enter your NCPDPs, and click Search. We'll try to fill in as much information as we can.
If you choose "Save and finish later", we will send an email to the "Owner Email" address on the first tab below which will allow you to return to the form.
This icon denotes information that may be common across all stores. Clicking it will copy the value entered on the first tab to the respective field on this tab.
Pharmacy Legal Name
Pharmacy Name (DBA)
Pharmacy Address
City, State Zip
Owner name(s) – if multiple owners, what is the ownership % of each owner?
Owner Phone Number (Best number to reach you)
Owner Email (Personal)
Absentee Ownership
Building Type
Hours of Operation
What % of prescriptions filled are narcotics
Percent of business Rx/OTC
Approximate store inventory
Front end:
Annual Sales Volume
Annual Script Count
Any pending PBM audits
Are licenses in good standing with DEA/BOP?
# Pharmacists (FT/PT):
# Techs (FT/PT):
# Clerks (FT/PT):
# Drivers (FT/PT):
Niche business and % of volume:
(CTRL+Click to select multiple)
Do you have mail order contracts?:
Are you a 340b contracted pharmacy?:
Does the pharmacy deliver?
Name of pharmacy system / POS
Size of the pharmacy (square footage)
Do you own the building?
Year pharmacy established
Year of current ownership
Primary Wholesaler
Primary PSAO
Do owner(s) want to continue working
Are you willing to consider seller financing?
Reason/motivation for selling:
Established sale price:
Additional information: