Invite-only onboarding

Request access for your pharmacy.

Tell us about one physical pharmacy location and its named administrator. Each approved pharmacy receives its own workspace and one approved administrator login after review.

1
Submit business informationNo patient, prescription, or pharmacy report data is requested.
2
Complete an onboarding reviewWe verify the pharmacy's business identity, legal owner, and authorized signer.
3
Execute the BAAAfter approval, the pharmacy signs through DocuSign and RxRecon Pro LLC countersigns.
4
Receive your invitationPayment, provisioning, and the administrator invitation follow only after the BAA is fully executed.

Pharmacy access request

Required fields are marked with an asterisk.

Pharmacy identity

Legal pharmacy name *

DBA / store name *

Enter the legal pharmacy name again if there is no separate DBA.

NABP / NCPDP pharmacy ID *

Seven-digit pharmacy identifier

Pharmacy NPI *

Ten-digit National Provider Identifier

Wholesaler account identifier(s) *

Enter the account or location identifier shown in your wholesaler export. Separate multiple accounts with commas. Do not upload a report.

Physical pharmacy location

Street address *

Suite / unit

City *

State *

Two-letter U.S. state abbreviation

ZIP code *

Named administrator and pharmacy contact

Administrator full name *

Administrator business email *

Pharmacy phone *

Pharmacy fax *

Primary interest *

Authorized BAA signer

Signer full name *

Signer title *

Signer business email *

This person must be authorized to bind the pharmacy's legal owner. The signer may also be the named administrator.

One pharmacy, one named administrator. Each approved access is licensed to one physical pharmacy location and one named pharmacy administrator. Credentials may not be shared. Each additional location or administrator requires separate approval.

Business information only. Do not submit patient information, prescription data, pharmacy reports, or other PHI through this form. Do not upload or provide dispensing files, wholesaler files, clinical notes, or patient or prescriber data.

I understand that access is limited to the pharmacy location and named administrator above, and that login credentials may not be shared. *

I confirm that this request contains only business contact information and no patient, prescription, prescriber, or pharmacy report information. *

I have read and agree to the Terms of Use and acknowledge the Privacy Notice. *

I have reviewed the reference Business Associate Agreement and understand that, if approved, an authorized representative must execute the pharmacy-specific agreement through DocuSign before payment, provisioning, invitation, or production use involving PHI. *

Submitting this form does not create an account, start a subscription, or execute a Business Associate Agreement. The BAA becomes effective only after authorized representatives of both parties sign through DocuSign. Questions? Email ADMIN@RXRECONPRO.COM.