INDIVIDUAL PROFILE FORM


Please use your TAB key to move between fields.
The fields marked with " * " are required!
NAME: *
 
Company/Hospital: *

ADDRESS: *

CITY: *
STATE: *
ZIP: *
PHONE: *
E-mail: *
                               
Preferred Method of Contact:
E-mail (please make sure to include your e-mail address above)
Phone
Fax
Postal Mail
  
Experience with Pharmacy Outsourcing?:
 Yes
No
If yes, what company?:
                
I am interested in*:
Full Service Pharmacy Management & Support
Pharmacy Consulting Services
Interim Pharmacy Staffing
Recruiting Services
                
Areas of Interest *
Automation / Dispensing
Pharmacy Computer/Information System
Regulatory Survey Consultation and Preparation (JCAHO, CARF)
Clinical Pharmacy Programs
Formulary Development and Management
Inventory Management
Product / Charge Master Assistance
Pharmacy Purchasing Programs
<USP> 797
  

Comments/Questions:
  
How did you hear about PharmaCare Services?:
Direct Mail
Print Advertising
Website / E-Commerce
Referral From Hospital Doing Business w/ PharmaCare Services
Other:
Contact:
 Dawn Rana RPh
Business Development Director
800-656-6515
drana@pharmacareservices.com