Please fill out the pertinent information below for your business.  We will contact you within 48 hours with a complimentary projected savings analysis.

Name
Company Name
Email
Phone Number
Membership
?
Your total number of members (total covered lives)
Retail: Discount off AWP for Brands
?
Your percentage discount off of AWP for brand drugs at retail.
Retail: Discount off AWP for Generics
?
Your percentage discount off of AWP for generic drugs at retail.
Retail: Dispensing Fee
?
Your dispensing fee for drugs dispensed at retail.
Mail: Discount off AWP for Brands
?
Your percentage discount off of AWP for brand drugs in the mail.
Mail: Discount off AWP for Generics
?
Your percentage discount off of AWP for generic drugs in the mail.
Single Source Generics Included in Generic Effective Rate?
?
Yes or No