Pharma Application Form

Membership Application

To apply for membership please complete all questions.
We cannot supply pharmaceuticals to members of the public and we cannot accept prescriptions

Medisave UK Limited, as a licensed Wholesale Distributor of Medicines for Human Use, must ensure they supply medicinal products to persons who are authorised or entitled to sell or supply medicinal products to the public. Therefore, for us as your supplier to comply with the strict regulations, we must ensure we validate your organisation, yourself as the authorising health care professional and any persons whom you authorise to purchase and receive medicinal products on your behalf. This does NOT affect any non-Pharmaceutical items your surgery may purchase from us.

Pharmaceuticals can only be ordered via an official purchase order or via the website and only by yourself or the persons you have named as authorised to purchase and receive medicinal products on your behalf.

By signing this document. You are confirming that you are the authorising healthcare professional for your organisation and that you will ensure there is no misuse in relation to ordering and receiving medicinal products. We reserve the right to withdraw supply if evidence of misuse or abuse is detected.

Please download our pharma terms and conditions by clicking here.

Please allow 72 hours after submission for your account to be approved.
Organisation name*
Name*

First NameLast Name
Email*
example@example.com
By signing this document, you are confirming that:
- you are the authorising healthcare professional for your organisation;
- you will ensure there is no misuse in relation to ordering and receiving medicinal products;
- you have read and agree to the Pharma Terms and Conditions.
We reserve the right to withdraw supply if evidence of misuse or abuse is detected.
Organisation address (Delivery address)*

Street Address

Street Address Line 2

CityCounty

Postal CodeCountry
Telephone number*
Web address*
Authorising Dr/HCP details*

Rows Full name GMC/Equivalent number

Dr/HCP

Rows	Full name	GMC/Equivalent number
Dr/HCP

Name, email address and job title of persons authorised to order & receive medicines on my behalf as the authorising Healthcare Professional:

Rows	Name	Email	Job title
Person 1
Person 2
Person 3
Person 4
Person 5

Pharmaceutical Goods Terms and Conditions.

Orders containing Pharmaceutical or other regulated items are subjects to the following restrictions.

· The customer must have a registered account (i.e., not a guest account)

· All accounts will have an automatic £250 credit limit applied to their registered account, should be over your credit limit the account will need to be settled prior to subsequent ordering. Furthermore, if your order is over £250 it will need to be settled prior to shipping.

· The customer must provide a valid GMC number (or professional equivalent) during the checkout process.

· The delivery address must be a registered business address unless operating from a home or independent operator.

· Stock items will not be shipped with Pharmaceuticals.

· We do not accept prescriptions.

These requirements will be checked manually before any restricted products will be despatched. Once your account has been approved, this approval will be valid for 1 year unless the approved qualification expires in this time.

Please note your initial pharmaceutical order will not immediately be despatched due to the medicinal product customer approval process. This is due to Medicines being a controlled supply chain and we have a responsibility to ensure that the Human Medicines Regulations 20-12 are adhered to be carrying out checks on your authority to procure medicines. This process should not take any longer than 72 hours once all relevant information is available to the customer approval team.

The lead healthcare professional form we request you to complete must be completed by the person responsible for medicines with the authority to purchase the medicines you intend procure. If the form is completed by a secondary individual this will delay the approval of your account to order pharmaceuticals.

While approved, all pharmaceutical orders will be manually checked and then shipped with our temperature-controlled courier, Movianto (UK) Ltd.

If delivery is not successful, Movianto (UK) Ltd will try a secondary time before the goods will be returned to Medisave (UK) Ltd. Once returned the goods will be quarantined for destruction. Failed deliveries that are returned to Medisave (UK) Ltd are non-refundable.

Customers which are approved, Orders placed up to 12.00pm will be despatched on the same working day for next day delivery. Orders placed after 12.00pm will be despatched the next working day. Orders will only be sent Monday – Thursday therefore any order placed after 12pm on Thursday will not be dispatched until the following Monday.

Any orders where a product is unavailable will be added to a back order list automatically and you will be informed of the delay.

Should you wish to amend or cancel an order placed, this will not be actioned unless received in writing.

Any identified shortages or damages must be reported to Medisave (UK) Ltd must be reported within 48 hours of receipt.

In the event, you have a concern in relation to the quality of a product received from Medisave (UK) Ltd please retain the defective product and contact us immediately.
Date of Signature*

MonthDayYear
Date
Authorising Dr/HCP Signature*

Clear
This MUST be signed by the authorising Dr/HCP. If another member of the practice signs, the application will automatically be rejected.
Should be Empty:

Membership Application