Pharmacy Registration

Pharmacy Details


Physical Address

Banking Details

Owner Details

Other Details

License Documents (Upload Required Documents. Max File Size 3MB)

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You can drop your file here or select filefrom here.
You can drop your file here or select filefrom here.

Review the following statements:

Has the owner or pharmacy ever had a DEA registration suspended or revoked ?

Does the pharmacy solicit buyers or orders of controlled substance via internet or offer to facilitate the acquisition of a prescription for a controlled substances from a practitioner with whom the buyer has no Pre-existing relationship via online questionnaire without a medical examination or bona-fide doctor-patient relationship ?

Does your pharmacy have a website ?

Is your clinic or pharmacy affiliated with another pharmacy?

Are one or more practitioners writing a disproportionate share of the prescriptions for controlled substances being filled by the pharmacy?

Does the pharmacy offer to sell controlled substances without a prescription?

Any exceptions/circumstances where the pharmacy doesn't follow procedures to verify prescriptions and validate bona-fide doctor patient relationship?

Any exceptions/circumstances where the policies and procedures set by the pharmacy/clinic to prevent the diversion of any medication by staff employees /patients/other are not used?

Does the pharmacy/clinic fill prescriptions for patients who are not domiciled in the state they are located in?

Have any corporate officer/owner/pharmacist of the pharmacy ever been charged,convicted,plead no contest or had adjudication withheld on any charge involving possession , use or distributions of controlled substances under the federal controlled substance act or any state laws pertaining to controlled substances?

Compounding Pharmacy

Administer vaccinations

Agree to follow all federal and state regulations including Drug Supply Chain Security Act (DSCSA).

RxShelfSpace requires a copy of valid pharmacy state license permit and DEA prior to final approval.

I certify that the above information is true and accurate and will buy or sell only small quantities of non-controlled, non-expired overstocked prescription drugs and drugs in short supply, to satisfy a specific patient need or declared public health emergency to other pharmacies on RxShelfSpace Platform. Pharmacy will not sell Items originally acquired through government discount programs. The posting and sale of items acquired through government discount programs (i.e. 340b) is strictly prohibited. Such violation will result in the temporary or permanent dismissal from the RxShelfSpace Platform. Pharmacy will not Sell Recalled, Quarantined, or Otherwise Adulterated Drugs Under State and Federal Law. Pharmacy will not post isotretinoin or clozapine prescription drugs on RxShelfSpace Platform. Pharmacy will not post Stolen Property and Sample Prescription Drugs or Promotional Materials.

Check this checkbox if you agree to the terms and conditions above.

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Address:

RxShelfSpace
2655 Philmont Ave.
Suite 210
Huntingdon Valley, PA 19006

Email:

hello@rxshelfspace.com

Phone:

+1 (848) 420-0199

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