Pharmacies

If this is your first time here:

Please complete the Pharmacy Application below
Once approved you will receive a "Welcome" email with login instructions
If for some reason you do not hear from us within 2 business days, please contact us to check the status of your application.

If you have any questions or require support:

You can reach us at 502-709-7544 or via email at info@mainpointepharmaceuticals.com

Pharmacy Application

Pharmacy Name*
Pharmacy MBR DEA*
PDF Copy of Current W-9*
Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.
PDF Copy of Resale Tax Certificate.*
Accepted file types: jpg, gif, png, pdf, Max. file size: 50 MB.
Primary Contact Name*
First Last
Primary Contact Email*
Pharmacy Login Password (your email is your username)*
Enter Password Confirm Password
CAPTCHA