Acquisition Inquiry Questionnaire

Please note that we are only seeking to acquire compounding pharmacies. We are not interested in retail community pharmacies, specialty pharmacies, or long-term care pharmacies. Please DO NOT complete the form unless you own a compounding pharmacy.

*Note: We are open to buying the compounding prescription portion of your business.

Pharmacy Assets (Book of Business)Pharmacy Location and AssetsEither Assets or Location

Name*

First NameLast Name

Pharmacy Name*

Corporate / Legal Name*

Legal Entity Type*

YesNo

What is the name of the Holding Company?

If so, please describe the company structure.

Pharmacy Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

YesNo

Website*

Email Address*

example@example.com

Published Phone Number*

Area CodePhone Number

Direct Phone Number*

Area CodePhone Number

Pharmacy Fax Number*

Area CodePhone Number

Monday-FridaySaturdaySundayOther

Years in Business*

How many years have you been in business at this location?

Do you own or lease the building in which the pharmacy is located?

If leased, when does the lease term expire?

What is the monthly mortgage / lease payment?

Can the lease be extended?

What is the pharmacy setting?

Clinic, Strip Mall, Grocery, Stand Alone, etc.

Total Sq. Ft. / Front End Sq. Ft. / Pharmacy Sq. Ft.

Type of compounding pharmacy and area of focus *

ex: pet medicine, hormones, pain, sterile/non-sterile

What is your reason for selling?*