LTC Pharmacy Subscription

$80.00 / month and a $100.00 sign-up fee

Pharmacy Sign-Up Form

Information for A Place for Meds website

Pharmacy Name*
Pharmacy Address*
Pharmacy Phone Number*
Pharmacy Email*
Pharmacy Website URL*
Sales Contact Name
Sales Contact Phone Number And/ Or Email
Customer Service Contact Name
Customer Service Contact Phone Number And/ Or Email
What States and areas do you Service?
Which Types of Customers do you Support?*
Which Services do you Provide?*
Which Offerings do you Provide?*
Pharmacy "About Us"*
Why Should Prospective Customers Choose You?*
Be specific
Quotes from Customers
With multiple quotes, double enter between
Pharmacy Pictures and or Logo
Drop files here or

Max. file size: 512 MB, Max. files: 4.

The aplaceformeds.com subscription allows the LTC pharmacy to be published onsite which will include marker on map and a full web page designed to promote the services and offerings of the pharmacy. Please fill out the web form below to provide us with the information about your retail pharmacy that will be posted. Price is for each pharmacy location.

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LTC Pharmacy Subscription

Pharmacy Sign-Up Form

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