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Independent Pharmacy - On-line Questionnaire or pdf Form
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If you do not receive an e-mail message within 30 seconds after pressing the “Submit” button, please check your Junk e-mail folder. If no message was received, you can complete the questionnaire using the pdf version of the questionnaire attached below.
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If you still have trouble opening or viewing this file, please call Customer Support at
901-373-9314
.