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Pfizer products: Aricept, Bextra, Celebrex, Diflucan, Lipitor, Zoloft, Zyrtec are available for shipping from Canadian pharmacies



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If you own or operate a pharmacy in Canada and are committed to high standards of patient care and would like to become our Participating Pharmacy Provider, please complete the following preliminary application form:

* Required Fields

*Your Name:

Your Title:
*Pharmacy Name:
License Number:
Pharmacy Web Address:
*Address:
*City:
*State:
*Zip:
*Tel:
Altern. Tel:
Fax:
*E-mail:

*Best time to reach you:

 

A.M. P.M.

 
*Please tell us about your company:

*Can your company handle large volume of daily Prescription Order? If yes how many?

 

*Did your Pharmacy(s) or any individual Pharmacist (s) employed or contracted by you have had any applicable license(s) suspended or revoked in the last 5 years? If Yes, please explain:

 

*Were there any legal or disciplinary action(s) brought against your Pharmacy(s) or any individual Pharmacist (s) employed or contracted by you in the last 5 years? If Yes, please explain:

 

*Please give an sample of your prices in USD for such popular medications as Celebrex, Claritin Lipitor, Zocor, etc.**

 
*Please let us know of any other fee(s) or charges that you might have besides the cost of medication(s)


*How did you hear about us?
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** Feel free to e-mail your complete medication pricelist to . Please make sure to indicate if the prices are in Canadian Dollars or USD. Disount Canadian Pharmacy, On line pharmacy in Canada


 
 
 
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