| Prompt |
Response |
Req |
Len |
| Pharmacy Code |
Type the code you want to edit or create or click the magnifying glass to search the table. This code cannot begin with a zero. |
|
5 |
| Pharmacy Name |
Type the pharmacy name. |
 |
45 |
| Address Line One |
Type the pharmacy's address. |
|
40 |
| Address Line Two |
Type any additional address information. |
|
40 |
| City, State |
Type the city and state. It should be entered in the exact format shown. For example, Phoenix, AZ. Type the city name - then a comma - then one space - and the two letter state code. |
|
30 |
| Zip Code |
Type the zip code. |
|
10 |
| Contact Individual |
Type the individual to contact at this pharmacy. |
|
30 |
| Telephone Number |
Type the phone number for this pharmacy. |
|
15 |
| Fax Number |
Type the fax number for this pharmacy. |
|
15 |
| Comment |
Type any neccesary comment text. |
|
40 |
| Comment |
Type any neccesary comment text. |
|
40 |