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My Pharm Start Up Blog. No Retail Experience, No Partners, Quit current job.

Discussion in 'Pharmacy' started by Hpower12, 06.18.11.

  1. southpharmindy

    southpharmindy

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    SDN Members don't see this ad. (About Ads)
    Atlrph

    Most independents are members of buying groups. You should go to some of their meetings and talk to some owners. They're a great source of information and many of them will come right out and say if they are interested in selling their store or not. Some may even be interested in opening another location if the right partner came along.
  2. 504poboy

    504poboy

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    amerisource bergen is a sick wholesaler....i live in new orleans....when hurricane isaac came...they missed one day which was when isaac landed and they were there the next day but we were closed because we didnt have any power..they have great customer service
  3. 504poboy

    504poboy

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    has anyone used pioneer rx...its pretty sick as well..they have an ipad for signature capture and email/text notifications far superior than the pharmacy software we use...generates prior authorizations automatically without manually typing all the fields....any future owners should definitely check it out
  4. southpharmindy

    southpharmindy

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    Never seen pioneer Rx. What would the cost of entry be and what would their support look like? I also wonder how much they would charge for each claim.

    Def. like that they scan each prescription in and that they reconcile claims and rebill (in recent times we're getting hammered on hydrocodone prescriptions. It would be nice to be able to rebill these.)

    We use Rx30. Seems like most indy's I know use Rx30 or Qs1.
    Last edited: 09.18.12
  5. 504poboy

    504poboy

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    man lousiana medicaid is killing us now....they used to awp minus some percentage...now it is cost plus 10 dollars on everything no matter the quantity....we are losing money on some claims like pediatex td and suprax through la medicaid

    yeah pioneer rx does pre and post edit claims as well...we use a software company called carepoint and 3rd party switch called rx linc...we are getting ****ted on with the lortab and lorcet scripts....i try to get the doctor to write them for norco's 10/325....its becoming a payer driven world and bull**** price gouging on the wholesalers and manufacturers
  6. Doctor M

    Doctor M

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    Yeah, that seems to be the case with medicaid usually. With more and more people needing care, and with Obama possible reelection coming, you may see those numbers get worse.
  7. Fallsrx

    Fallsrx

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  8. 504poboy

    504poboy

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    i have been talking to the guys because im thinking about opening my own pharmacy soon....check this out....15,000 for a point of sale, server, and a computer workstation, you can add unlimited computer work stations later down the road for no add on fee...the rep told me you can buy a computer and monitor from best buy and add it on later for no additional fee cheaper that way...they have an app built in for smart phones for refills and email/text notifications for when the rx's are ready for 100 a month...340 monthly fee for support....24 hour customer service....currently we use this software called guardian rx made by carepoint which sucks ass...their customer support after hours is only for if your computer crashes....thats the most bull**** i have ever heard in my life...5 cent transactions....i asked them to send me brochure...their reply "We can't cause we update our software so much we would waste money on wasted brochures"...that kinda turned me on because the pharmacy software has to adapt to ever changing pharmacy environment....in louisiana we have to submit all our narcotics filled every 7 days to the state prescription monitoring program...its a pain the ass right now for me cause i have to manually do it every 7 days which takes me 15 minutes do...pioneer rx does it automatically at whatever time you want it to schedule it to....the rep was telling me some states have to send it in real time....man this company is exactly what i been looking for ever since pharmacy school...i used to rotate at other independents and their software was in the dinosaur age...one guy was using DOS based software....thats what made not want to open up a pharmacy because of software that was not adaptable to changing environment of pharmacy....they do online demos to people who are interested....i have one coming up soon after i get off work...i had one but it was right when work started...they do demos online in groups and then they give you a quote when you are done...
  9. southpharmindy

    southpharmindy

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    Poboy

    Seriously 14,000 sounds like a great price and it looks like it has a lot of features for a program for that price. I've heard some of the other systems like Qs1 run like 24,000. I think we pay 0.05 cents for each transaction but this new buying group has told us they will give us free transactions and 0.17 cent escripts.

    Also agree with you about using amerisource as a wholesaler. In 12 years they have never missed a shipment to our store and that is even with 2 feet of snow on the ground.

    How far are you along in opening your own store?
  10. kellison

    kellison

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    Southpharmindy,
    What buying group do you use now, and which new one are you looking at switching to?
  11. southpharmindy

    southpharmindy

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    Kellison,

    Which group are you in?
  12. kellison

    kellison

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    Southpharmindy,
    I'm not currently in one, seriously looking at putting my shingle out, so I'm trying to one the numbers, explore all my options and put a plan together.
  13. 504poboy

    504poboy

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    DHH Announces Adjustments to Pharmacy Reimbursement Change
    State will issue new emergency rule based on feedback from Louisiana pharmacists
    [​IMG] Friday, Oct. 19, 2012 | Contact: DHH Media & Communications; (225) 342-1532 [​IMG] Baton Rouge, LA - Today, Louisiana Department of Health and Hospitals (DHH) Secretary Bruce D. Greenstein announced adjustments to the Louisiana Medicaid program's pharmacy reimbursement methodology.
    DHH promulgated an emergency rule in August that revised its reimbursement methodology for pharmacy services from an Average Wholesale Price (AWP) model to an Average Acquisition Cost (AAC) model. This change is consistent with federal policy direction and is similar to policies other states have successfully implemented for their Medicaid pharmacy programs. Effective Sept. 5, Medicaid began reimbursing pharmacists for their prescription services to Medicaid enrollees at the Average Acquisition Cost (AAC) plus a $10.13 dispensing fee.
    In recent years, several national organizations have noted AWP-based reimbursement for Medicaid pharmacy is unreliable, subject to manipulation, and not representative of the actual purchase price for pharmaceutical products. A review of claims data showed when using the previous AWP reimbursement model Medicaid was consistently a top payer for pharmacy providers, paying more generously than commercial Pharmacy Benefit Management programs that serve patients with private insurance. As a result, a 2009 national Medicaid workgroup recommended state Medicaid programs shift their reimbursement methodology toward AAC to bring costs more in line with the actual cost of acquiring and dispensing prescription drugs to Medicaid recipients.
    "We've talked about this change in reimbursement for more than two years. Since its implementation, we've worked extensively with community pharmacists to examine the impact," Greenstein said. "Louisiana pharmacists raised specific concerns about how the new rates were being applied to our attention, and we've made changes to adjust reimbursement upward and address their concerns."
    In order to incorporate feedback from pharmacists, DHH convened a workgroup of both independent and chain pharmacists to discuss the new reimbursement structure. After careful analysis, including a detailed review of cost and reimbursement data through information submitted by community pharmacists, DHH has made several enhancements to the reimbursement methodology that will increase reimbursement for pharmacy services. The new items are:

    1. Provide a markup of 10 percent above the AAC rate for generic drugs, and 1 percent for brand name generics.
    2. Increase the dispensing fee paid to pharmacy providers as part of their reimbursement from $10.13 to $10.51, based on a factor of consumer price index inflation.
    3. Reimburse certain classes of specialty drugs, which cost more and are more complex to stock and dispense than mass-market prescription drugs, at their Wholesale Average Cost (a more generous price index) plus 5 percent.
    4. Closely monitor drug-pricing updates that manufacturers make on product and pass along to pharmacists, to ensure Medicaid can adjust to the updated pricing quickly and accurately, which will limit instances where pharmacy reimbursement is below the cost of acquisition.
    Medicaid made these changes to better use taxpayer dollars by more effectively containing costs in the program, while providing a fair reimbursement for pharmacists. Given Congress' unexpected reduction in Louisiana's Medicaid reimbursement rate to the lowest point in 25 years, Greenstein emphasized the importance of balancing the budget, living within the state's means and more effectively using taxpayer dollars.
    "Due to Congress' reduction in Medicaid funding to Louisiana, we must look at how we can operate in a more effective and less expensive manner," Greenstein said. "In making these changes, our top priority is ensuring Medicaid recipients have access to the prescription drug services they need, while also ensuring that we make optimal use of taxpayer dollars and that our pharmacists are paid a fair and transparent reimbursement."
    "I want to recognize the members of the House, particularly the Health and Welfare Committee, for their strong advocacy on behalf of the pharmacists in Louisiana," said House of Representatives Speaker Chuck Kleckley. "I also want to thank the Department for their willingness to listen and respond to pharmacists' concerns. Secretary Greenstein has made a commitment to continue their dialogue, and House members will closely monitor their progress."
    "I'm pleased with the progress we've made by bringing all parties to the table to determine the best path forward for the Medicaid pharmacy program," said Senator David Heitmeier, Chairman of the Senate Health and Welfare Committee. "DHH and the Legislature are committed to making necessary adjustments to these policies, and will continue to closely monitor the data to ensure that we are paying a fair rate for pharmacy services."
    "The pharmacies in Louisiana continue to work to be accessible to the population of the state needing necessary prescription drugs, regardless of the payer," said Randal Johnson, President and CEO of the Louisiana Independent Pharmacy Association. "The move by DHH to address shortfalls in funding is something that our small business community pharmacies understand and respect as members of the tax-paying public and as health care providers. We appreciate the willingness of DHH to continue to review the information and work toward a fair and transparent reimbursement methodology."
    "On behalf of our chain pharmacies operating more than half of the retail pharmacies throughout Louisiana, we are encouraged by the Department's willingness to continue these discussions and make adjustments where appropriate," said Mary Staples, Director of State Government Affairs with the National Association of Chain Drug Stores. "We've been working with DHH for over a year on this issue, and we look forward to continuing our positive relationship as we observe the impact of these reimbursement changes."
    The Department is promulgating the new emergency rule, which will implement the updated reimbursement methodology changes for Medicaid fee-for-service pharmacy claims with dates of service Nov. 1, 2012 and beyond. Like all reimbursement changes, these adjustments in methodology will be subject to federal approval by the Center for Medicaid and Medicare Services (CMS).
    The Louisiana Department of Health and Hospitals strives to protect and promote health statewide and to ensure access to medical, preventive and rehabilitative services for all state citizens. To learn more about DHH, visit http://www.dhh.louisiana.gov. For up-to-date health information, news and emergency updates, follow DHH's blog, Twitter account and

    I'm waiting until december-january to see the reimbursements..Louisiana medicaid used to pay the pharmacy every 7 days now they moved it up to 14 days....I'm thinking about using ANDA pharmaceuticals and PARMED for drugs...Amerisource wants all these bull**** financial documents before you even apply....PARMED and ANDA i can use my personal credit card to pay off the initial ordering as I go by...then later go to Amerisource
  14. southpharmindy

    southpharmindy

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    Kellison

    Check out Smartfill and American Associated Pharmacies depending on your area. What part of the country are you in?

    Poboy

    I really like ANDA and Parmed as a secondary but who will you get your brand drugs off of? Have you talked to a buying group>
  15. kellison

    kellison

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    I'm in North Central Florida area, Gainesville, FL
  16. kvl1027

    kvl1027 Member

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    You can scan Rx's in with Rx30 and reconcile and rebill.
  17. kvl1027

    kvl1027 Member

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    I'm with AAP and really like them, great rebates. The only issue I have with them is their return policy kind of sucks.
  18. kvl1027

    kvl1027 Member

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    I wished FL Medicaid paid a $10.15 dispensing fee + AAC
  19. Hpower12

    Hpower12

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  20. Hpower12

    Hpower12

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    We averaged over 50-60/day last month and hit 60k in ordering volume.

    Looking at that cms certification for DME as a goal for next year. Working on getting immunization certified still, the area is not very conducive to high end compounding.


    For some of the veteran owners, anyone have any.advice on how to get a.doctors practice in the building your are in. Assuming you own the plaza or.building. I have briefly heard of going to MD conferences or job fairs, any other ideas?
  21. Probicon

    Probicon

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    You should have called me and it would have been a turnkey business for you. Let me know if you are ready for your next pharmacy because I have 2 golden opportunities in Fort Lauderdale, Florida.

  22. Probicon

    Probicon

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    It looks like your headed in the right direction. Good luck, if you need help with anything we are experts in independent pharmacies and start ups. Also check out www.mediportsupply.com , they can help you generate foot traffic to your store.

  23. think

    think Junior Member

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    hello there,
    This is a great thread. I have learned so much from reading about your experience. Best of luck!!
    I have one question for everyone here-How long does it take to actually open a pharmacy for business after the application goes out?
  24. Hpower12

    Hpower12

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    Well I know in Florida right now the limiting factor is the DEA permit, I have heard they are taking. 8 months. There great way on ccontrolling the diversion, pharmacy and pharmacy wholesalers are the "choke point" in the supply chain. To hard for them to shut down all the doctors, its on us. I would say 6-8months is a reasonable time frame.
  25. Hpower12

    Hpower12

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    I would also say never stop asking questions, many times now I know more about the internal workings of my wholesaler than my reps do. Make connections and just keep asking questions, find out what motivated them and how decisions are made and who makes them and what actually matters.

    I know the delivery driver well and have his cell #, if I need a favor I can call it in and throw a favor his way. I have wanted to say, "what would it take for you to lose or deliver extra late a walgreens or competitors delivery for the day" but, everyone out there can have info so get to know them all.
  26. kvl1027

    kvl1027 Member

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    Average of 9 months right now. Gotta get your medicaid and medicare provider numbers, that can take a while. And you should not open until you can bill medicaid, otherwise....death sentence.
  27. kvl1027

    kvl1027 Member

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    It's funny you say that, cause we always have coffee waiting for our Cardinal driver and now he delivers to us first....:laugh:
  28. think

    think Junior Member

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    thank you all for the input. I was considering going this route but not even sure what to do any more I don't have a full time job my loans are not getting paid. I was thinking of maybe opening a pharmacy but I think that would be suicide for me right now.Now I am considering moving to somewhere like Alaska so I at least I can pay my loans off. I feel like all these years of hard work in school has not paid off at all :(

    Anyways best of luck with your pharmacy it is great to know how well you are doing I am a strong believer in God and seems like he is definitely helping you out right now :)
    I will keep on reading this for ore advice :)
  29. 504poboy

    504poboy

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    we use smartfill for our buying group....so they give us 10 percent back on all generics on the backend in a form of rebate check at the beginning of the month...this causes an artificial higher acquisition cost on the front end so the PBM's do not see the true acquisition...which means higher reimbursements...

    if anyone is reading this every wholesaler has an authorized secondary wholesaler...amerisource uses a company called bellcodrug....your ordering rep is not going to tell you this because they want you to do their one stop shop for all your generics with the primary wholesaler so they can rape you on their generic drugs...

    another secondary wholesaler that is way cheaper than parmed and anda is gensource...i got quotes on all my generics they blew ANDA, parmed, and Amerisource out the water....they get majority of their drugs from aurobindo....still havent placed an initial order with gensource or bellco...will let you guys know in a couple of days
  30. southpharmindy

    southpharmindy

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    Poboy

    We're going with Smartfill as well. Seems like a pretty good group from what I can tell. Anything you particularly like or dislike about them?

    Im gonna check on Gensource. Thanks for the heads up.

    With me I always order from my primary unless something is unavailable or the secondary is much cheaper. I got Lovenox for almost 300 dollars cheaper from Parmed than Amerisource. If I had order from Amerisource I wouldve lost my shirt.
  31. Hpower12

    Hpower12

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    Depends on how much you know what your doing and having the right connections. Everything goes in a step wise manor. For instance, you need a BOP permetlrmit before getting DEA. And signing with a wholesaler. Not to mention county and city biz licenses (we pulled a good ole boy game on one of those) and their computers can go down or you filled out some paper work wrong.

    Just mentally prepare for delays at each step 8-9 months is realistic, not even factoring in the build out and code inspections.
  32. kvl1027

    kvl1027 Member

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    Does you buying group give you fatter rebates than your primary? They should. We use API and our entire order gets EDI to them, they fill what they can then send the rest to cardinal. Do all the work for me and my rebates are much better.
  33. tobie

    tobie Some call me a pharmacist

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    I would suggest having a primary Drug source and atleast 2 secondary ones. There have been many times where I saved 70% on specials the secondary vendors had on
  34. southpharmindy

    southpharmindy

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    Poboy

    You were spot on about Gensource. Some stuff is the same or maybe a little more expensive. However the majority of their stuff is anywhere from 10-50% cheaper than what I pay with Amerisource. If you save anything over 10% I guess its safe to say the heck with the rebates.

    KVL

    Yeah we get all of our rebates through the buying group. They cut us a check every quarter.
  35. southpharmindy

    southpharmindy

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    nm. double post.
    Last edited: 12.29.12
  36. Hpower12

    Hpower12

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    being in Florida how do you like Cardinal? Given their control issues? I was also told by a rep that since Cardinal has the CVS contract they give priority or allocate drugs in shortage to CVS before any independents. Any truth to this?


    Have any of you gone through the CMS DME certification? The new one where your store was not grandfathered in? I know their are several tiers and a few companies that can help with the compliance and preparing for the inspection.

    Also, for tax purposes, what does everyone do for inventory? I have heard there are companies that will come and inventory everything in your store to give you the costs of your current inventory including non drug items such as beer,soda etc. Any advice on this?
  37. 504poboy

    504poboy

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    i should have been more specific in regards what is cheaper.. gensource has all strengths of gabapentin that are half off price compared to anda and parmed......valtrex comes super cheap every once every 2 months.
  38. southpharmindy

    southpharmindy

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    Hpower how are things looking with your store?
  39. STAR3URY

    STAR3URY

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    looking forward for some new posts
  40. Patrickthetiger

    Patrickthetiger

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    Same here. Bump!
  41. Doctor M

    Doctor M

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    He is probably busy working them long ass hours that must be dome with a new store. Does he have a partner or is he doing this alone? Is he's doing this alone, i suspect he will be quite busy for some time.
  42. phampau

    phampau

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    In this quote, you are insinuating that you would rather take AAC + $10 dispensing fee as opposed to AWP -16% plus 3.73 dispensing fee? I am trying to understand in the end, which way has the better margin? It seems as though 504poboy is complaining that with the new Medicaid rules, reimbursement rates will decrease, but almost get you a net $10 dispensing fee per RX. I am doing my research on the Medicaid reimbursement rates looking to either open in Florida or Alabama in which AL uses AAC +$10 and Florida is awp -16% plus 3.73. Thanks for any insight anyone can provide on this. Paul
  43. Doctor M

    Doctor M

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    http://www.managedcaremag.com/archives/1203/1203.regulation.html
  44. southpharmindy

    southpharmindy

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    I'm not sure what to think about AAC.

    Whose acquisition are we going to use to base this system on? If we factor in hospital and mail order acquisition cost then we're screwed because the average retail pharmacy and small chain couldn't match this. Now if we use my actual acquisition cost +$10 I'll be happy as can be. I'd love to average 10 per script. We also need a formula to determine this dispensing fee to keep up with inflation.
  45. Doctor M

    Doctor M

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    Fat chance we will avg $10 per rx with medicaid. If anything, they will factor all pharmacys acquisition price and we will barely make profit, if at all. The state wants to pay the least possible. they dont care if we close or not. Only that they pay the lowest price possible.
  46. southpharmindy

    southpharmindy

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    That is exactly what I'm afraid of. Right now it is a guessing game for the PBMs. Nobody knows our actual cost with our rebates and such. If they found it I can see them trying to reimburse us 3-4 dollars on average or cost.
  47. Doctor M

    Doctor M

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    below cost
  48. rmflawk

    rmflawk

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    I am planning to open a pharmacy soon and remodeling is done but got stuck in the process. PLEASE help me...
    Here are a couple of thigns I need to get info about

    1.Any suggestion on the software? I contacted pioneer rx and it looks ok but they DO NOT sell the software, they LEASE it. You cannot sell the software to other pharmacy, for any reason you close your pharmacy (or maybe when you retire). I think it is unfair to charge for software and monthly fee even though a company does not sell it but lease it.
    Anybody use RX30?? It looks kind of old and not much info showing on the main screen.
    I kind of like window based software.
    Any opinion on Best RX or Winrx (too expensive but looks good-I heard it is a lease too) or super scripts or any other software out there??? Which one is the best when factoring in the cost and funtionality??

    2. Dose anybody know if a pharmacy balance has to be NTEP certified or not??

    3. Do measuring devices (like graduated cylinders...) have to be class A too? (did not know it comes that way before)

    4. On pharmacy permit application, do I have to check a box for compounding and delivery when I only occasionally mix oint. or cream or powder in them (just like any retail store) and deliver meds for my friends and church members MYSELF?

    I have been trying to contact board of pharmacy with these questions but they are never there and never called back :mad:

    Any input will be greatly appreciated. Thx in advance :love:
    Last edited: 03.25.13
  49. southpharmindy

    southpharmindy

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    Pharmacist
    SDN 2+ Year Member
    I like Rx30. Lot of great features if you activate them and its really fast. Its also cheap, easy to understand, and has unmatched support. Have worked with Rite Aid, CVS, Kroger, and Walmart and Rx30 is my fav next to Walmart.

    Your scales do have to be certified by the state. Don't worry about the measuring devices. Don't worry about checking compounding either; pretty sure they are just worried about sterile compounding.

    Who is your wholesaler and what kind of deal are they offering?
  50. rmflawk

    rmflawk

    Joined:
    05.16.12
    Messages:
    7
    Status:
    Pharmacist
    I do not have wholesaler yet but if I go with Rx30 I think I have to go with API. They have a deal with Rx30.
    It is hard to get a wholesaler now. They are almost nasty to deal with.:mad::mad:
    Any good advice?

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