A- A - It belongs to a chain that is already part of the program and wants to register one or more new points of sale?
B - Do you belong to a new pharmacy or pharmacy chain that wishes to enroll in the program?
B1. Commercial name of the Pharmacy:
B2. Check the options with which your pharmacy counts:
Option A: Phone
Option B: Internet access
C - Do you agree to register the purchase and exchange immediately?
You are being informed that:
01. You must have your inventory for the delivery of the exchange to your patient, immediately.
02. You will receive the replacement of the product exchanged within a maximum period of 15 days, by the distributor.
01. Number of physical or legal identity card with which the pharmacy is registered
02. Name of the legal representative
03. Identity card of the Legal Representative:
04. Email of the legal representative
05. Name of the person who will administer the program at the pharmacy
06. Number of the person who will administer the program at the pharmacy
07. Email of the person who will administer the program at the pharmacy
08. Name of the person requesting to participate in the program
09. Email of the person requesting to participate in the program
10. Distributors with whom you work:
11. Way in which do you want to receive a refund of your exchanges