DiversifyRx Corporate Membership

An option for industry companies committed to helping independent pharmacies thrive.

Terms:

$1,000 / Year

First Name:* First Name Required

Last Name:* Last Name Required

Address Line 1:* Address Line 1 is Required

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City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Pharmacy Name:* Pharmacy Name is Required

Please identify your role in the pharmacy.:* Please identify your role in the pharmacy. is Required

Pharmacy Owner Pharmacist/Technician/Clerk Marketer/Other Staff

Your Cell Phone:* Your Cell Phone is Required

Pharmacy Business Phone:* Pharmacy Business Phone is Required

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Password Strength

Description	Amount
DiversifyRx Corporate Membership – Initial Payment	$1,000.00
Total	$1,000.00

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DiversifyRx Corporate Membership

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