New Provider

The following information will allow a provider to be given a login and prescribing privileges in the prescriber portal used by Pure Pharmacy. Once received, you will be entered into our system and sent a username and temporary password via email listed below. Please call us with any questions.

Attention:
Pure Pharmacy is a 503A compounding pharmacy. Per federal and state law, all prescriptions sent to us require the following:

• Patient-specific prescriptions
• Patient-specific directions
• A direct patient-provider relationship must be established prior to dispensing
• Office use prescriptions are prohibited

By completing this form, you are agreeing to only send prescriptions that follow the guidelines listed above.