Retail Pharmacy Mangement Services, Inc.
P.O. Box 380
100 South 2nd Avenue
Madill, Oklahoma 73446

Toll-Free Number:
Local Number:
Fax Number:

(800) 662-9035
(580) 795-9944
(580) 795-7738
RPMS On-Line Submission Form
Instructions: Please complete the form below and submit. Thank-you.
Pharmacy Name:    
Owner's Name:  
Mailing Address (Street, P.O.)
  
City:  
State:  
Zip:  
Telephone Number:  
Fax Number:  
Email Address:  
Number of Locations Owned:  
Primary Wholesaler:
Buying Group or GPO Affiliation
Estimated Monthly Purchases:
Pharmacy Software Provider:
Average Number of Rx's Filled per Day:
Is this a Compounding Pharmacy?  Yes      No
Comments:

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