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.

Interested in selling

Name

First NameLast Name

Pharmacy Name

Corporate / Legal Name

Legal Entity Type

Is there a Holding Company?

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

Does the pharmacy have more than one physical location?

Website

Email Address

example@example.com

Published Phone Number

Area CodePhone Number

Direct Phone Number

Area CodePhone Number

Pharmacy Fax Number

Area CodePhone Number

What are the Pharmacy’s Open Hours?

Other

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?