Home » Start Your Account

Start Your Account

Home » Start Your Account

Create Your Account Today

At our compounding pharmacy, we offer personalized medications tailored to your unique needs. Our expert pharmacists specialize in creating custom formulations to treat a range of conditions. Partner with us today and experience the difference of individualized care for your patients or clients. Open an account now to start benefiting from our extensive range of compounded medications.

Tell Us About Yourself

Clinic Name:(Required)

Clinic Address:(Required)

Street Address Address Line 2 City State ZIP Code

Clinic Contact Phone:(Required)

Clinic Email Address:(Required)

Email Address Confirm Email Address

Provider Name:(Required)

Provider NPI:(Required)

Provider DEA (if applicable):

Additional providers' names (if applicable):

Additional providers NPI (if applicable):

Additional providers' DEA (if applicable):

Describe Your Patients

Estimated number of prescriptions per month:(Required)

State where your patients are located in order from highest concentration to lowest:(Required)

Terms and Conditions, Credit Card Authorization & Recurring Payments

Clinic Payment Information will be collected via PandaDoc once your account is approved.

Here’s How Recurring Payments Work: You authorize Rush Pharmacy to charge your credit card or your ACH account when you submit an order for a prescription product with us. Both will be required to set up an account with us.

Recurring Credit Card/ACH Authorization Prescription product orders will be automatically charged daily to your Visa, MasterCard, American Express, Discover Card or ACH upon your submission of a prescription order to Rush Pharmacy.

Terms and conditions *(Required)

I attest that I have read and agree to the Terms and Conditions.

Today's Date:(Required)

With my signature below, I agree to the terms and conditions*(Required)

After submitting your form, please wait for the Thank You message.

Start Your
Account

Get our full catalog with pricing information.