Form for pharmacies

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If your pharmacy is already enrolled in Celebrate life, Enter here::

Check the box for the options you have or agree with. If you do not have the requested information or do not agree, leave the box unchecked.
Which of the following options pertains to your case?

You are being informed that:
  1. You must have the inventory available for the immediate delivery of the redemption to your patient
  2. You will receive replacement of the redeemed product within a maximum of 15 days afterward by the distributor.
Pharmacy name Address Contact Name Phone Email Province Canton District
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