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Opening my own store. Posting my experiences.

Discussion in 'Pharmacy' started by Riskybusiness, Sep 26, 2018.

  1. Riskybusiness

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    I just can't take working in retail pharmacy anymore. I am getting killed 500+ days no help every phone line on hold. No respect, I am sure everyone here can relate to this. I am not going to post location yet. I will post what it takes to open a pharmacy and where it is going. Hopefully, I will learn and have some positive helpful posts in return.
     
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  3. TerryTerry

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    Good luck. We do and will appreciate your productive posts.
     
  4. Unchained

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    You're name of riskybusiness is apropos. I wouldn't recommend opening a business in an area where there is heavy regulation, declining reimbursements, DIR fees, a movement to regulate prices, consolidation, heavy competition and inventory carrying costs. Pharmacy is overdue for disruption. By opening a store you're doubling down on a profession/business model in decline.
     
    Riskybusiness and projektreverb like this.
  5. Sabril

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    Best of luck. It's doable. I don't own my store but it has been running for 8 years with like three or four major chains right around the corner. I can't say it's mega profit but it is going (without filling juicy scripts). I think it is just primarily location, customer service, and hire the right people (and we are meh in all of them for that matter)
     
  6. Superlarson5

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    Do you plan to provide mail order services? I wonder what it takes to do it.
     
    moose10 likes this.
  7. CetiAlphaFive

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    Cool.
    I look forward to reading your posts.

    If there's anything I might be able to help you with, my PM box is open
     
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  8. KennethCool

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    As the schools churn out more grads and saturate all available job openings, our wages will come down. This will lead to extra profits for pharmacIES (but not pharmacISTS). Owning a pharmacy is a really good idea when you know that you're going to be getting cheap labor very soon. I have the same idea as this guy. I am investing heavily in the pharmacy chain stocks, as their biggest expense (us) is coming down in price.
     
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  9. Unchained

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    Lower wages is just one variable in the long equation of pharmacy profitability. When suppliers, insurance companies, drug manufacturers realize that pharmacies are making more money as a result of lower wages then they will just lower reimbursement. Understand that we have no leverage.
    There are much better places to place your money than pharmacy stocks for the same reasons. Tech stocks have been hot. I could've bought CVS a year ago and made a whole $10/share. Instead I bought Amazon, nvidia and Google. Check their charts. I think you're just investing in what you know and are familiar with.
     
  10. PharmDBro2017

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    Good luck, keep us updated OP.
     
  11. Sabril

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    True about the cheap labor but I am not sure if the profit and volume for a small independent can warrant the hiring of another pharmacist. And cheap techs-forget it. I don't know of many pharmacist-owned stores that have to hire another pharmacist if they can help it. Even if I can somehow find a pharmacist for $25 an hour, I would think twice about trusting that person with my business. Everything still has its own price in any economy I guess.
     
  12. CetiAlphaFive

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    The average CVS or Walgreens pharmacist wouldn't survive in an independent.

    1.) They have to speak English

    2.) You actually have to be good at the job
     
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  13. JamesL1585

    JamesL1585 TheAntiSavior?
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    If you people knew the technology coming through the pipelines, and how some people (like myself) are looking into solutions to help independent pharmacist, you'd feel some relief. Being less cryptic, check out company's like Phil (Phil: Same copay, Free delivery, Real service). I think this is just the beginning, and with the war against the PBM's (finally!), the next 10-15 years, we know big community pharmacy is going down the drain, but there just "maybe" is a hope and opportunity for independent pharmacy owners. If I were still practicing, I'd find a location where a CVS/WAGS or otherwise just closed up shop, and put my pharmacy near that location. Even better, if they "recently" closed, they sell all of their supplies for pennies to whoever wants them. (i.e. shelves, computers etc.). PM Me for more insight.

     
  14. wagrxm2000

    wagrxm2000 Do not respond to this
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    I see nothing unique about Phil, mail order isn't new.

    Walgreens is going to destroy this company once their pick up on the same day service gets up and going and is perfected with all insurances.

    Probably one of the biggest complaints is having to come in multiple times a month, little reason to use mail order now.
     
  15. JamesL1585

    JamesL1585 TheAntiSavior?
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    I don't know what you're talking about. Nothing in this post coordinates to the next point, and there are many contradictions in your few sentences.

    Phil gives independent pharmacy's the opportunity to compete by bringing in customers (by stretching borders). An independent pharmacy that has more reach throughout their state is better off.

     
  16. wagrxm2000

    wagrxm2000 Do not respond to this
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    It doesn't change anything. Is this not a mail order service?

    They are too late to the game. Who are they going to convert?

    So I read some customer reviews and they are bad. Sounds like it's horrible customer service and delivery is not on time which I guess is more on the independent then Phil.

    What were my contradictions? I said two things which summed up we're convenience which Walgreens is fixing.
     
    #15 wagrxm2000, Sep 29, 2018
    Last edited: Sep 29, 2018
  17. CynicalIntern

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    Phil is actually about to be the victim of the latest CVS Caremark provider update, which states that "any pharmacists who receive copay card information from a hub versus the patient themselves will be subject to the recoupment of any and all funds" which basically is going to put them out of business if I'm interpreting this update correctly.

    Also, I work with a number of dermatology offices. They refuse to use Phil when a rep comes in using them, because they have no way of knowing what pharmacy it is actually being filled at which is a nightmare for quality assurance.
     
    DOOM N GLOOM likes this.
  18. JamesL1585

    JamesL1585 TheAntiSavior?
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    All "maybe", "possibly" situations. Next, the legality of CVS stance is completely questionable, as the "hub" is acting as a patient representative. Which last time I checked is completely legal in healthcare, and this could be more problematic for CVS if they fight it.

    Your second point is easily amendable.

    Benefits > Risk.
     
  19. wagrxm2000

    wagrxm2000 Do not respond to this
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    There's two types of customers, those that like mail order and those that want to get out and about.

    Mail order will never be cheaper with an independent which is the whole point. It used to be convenience, but that will soon be gone. You think a customer wants to wait for their mail hoping it will come in on time instead of just going in and getting all their meds at the same time? I think not unless it's significantly cheaper.

    This company is lucky there are people willing to invest in anything.
     
    #18 wagrxm2000, Sep 29, 2018
    Last edited: Sep 29, 2018
  20. CynicalIntern

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    I don't think you understand how contracts work. CVS sends out a contract saying "you cannot accept copay card information from a hub" and surprise, you now cannot accept copay card information from a hub. I don't care what kind of logic pretzels you twist yourself into in saying "we're acting as a patient representative (CVS likes to call patients and ask if they know the person that is acting as their representative. That should go well), unless Phil is going to actually put some skin in the game, no pharmacy is going to be willing to take that risk over the extra $25/script for 40 scripts a month that Phil gives them when a single script chargeback will negate that.

    If Phil wants to keep their business model afloat, they're going to have to actually become a *pharmacy* company and not a *data-mining* company. Because after 5-10 pharmacies start getting charged back for the claims that are sent to them from Phil, they're actually going to have to fill their own scripts versus relying on "pharmacy partners" to take all the liability.
     
  21. CynicalIntern

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    Phil isn't even a mail order pharmacy. They're not even a pharmacy. They partner with a manufacturer for discounted self pay cost and have their sales reps tell the doctors to send the prescriptions for the drug into PhilRx. If it's covered by the insurance, they apply a copay card and call the patient to confirm they're okay with the price, then transfer the information to an independent affiliate to fill and deliver. If it's not covered by the insurance, they do the same thing only using their limited proprietary copay card *~*only available to Phil pharmacies*~* (which is anticipated to be the next addendum to the CVS Provider manual) to bypass the insurance. They don't actually fill any prescriptions, but they collect the data from all the prescriptions being sent to them and sell it back to pharma in exchange for the data. All of the liability is placed on the dispensing pharmacy, and being as it's 70% straight copay card claims, they make about $30 per prescription for however many scripts get sent in. If that's the forward-thinking pharmacy processes of the future, then we should probably just retire now.
     
  22. wagrxm2000

    wagrxm2000 Do not respond to this
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    I never said they were a pharmacy, it's still mail order though whether it's delivered or shipped.

    I see no reason for this service expect for a couple business owners taking advantage of Independents.
     
  23. JamesL1585

    JamesL1585 TheAntiSavior?
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    You sound knowledgeable, but not sure where you're getting your intel from. About the contracts from CVS, about how Phils models work, etc. Your analysis (based on wherever) sounds great, but, unless I see the same info you do, then I just have to take it as hear-say (which is all I consider it), but I do know how startups work. Phil doesn't publish a lot of information about their company, like most startups, and I think they'll figure it out at the end of the day, as pharmacy isn't as hard to navigate as you think, and healthcare is changing quicker than ever before.

    May I remind you that PBM's are under siege? Their practices, models, and everything in between is in question, and also, I remember Pillpack having a similar situation with ExpressScripts. Which got resolved.

    Appreciate your insight, but it's almost like you're teaching a class with no textbooks or works cited so I can come to the same conclusion as you, making your words sound factual.
     
  24. CynicalIntern

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    [​IMG]
    Here's your CVS Contract addendum. My analysis is based off the conversation I've had with my audit protection agency, PAAS National. My understanding of their business model is because they approached me to be part of their "independent pharmacy network" and I turned them down after hearing their spiel, because they did not offer anything that I could not provide myself and it fact their haphazard handling of customers would be deleterious to the reputation of my pharmacy.

    PBMs are very much under siege, and I'll agree with that. Pillpack is a false equivalence though, because Pillpack was actually a pharmacy, and was the sole person impacted by any contractual problems with Express Scripts - so any decision made at the table impacted only Pillpack. Phil relies on thousands of pharmacies to do their dirty work for them, and doesn't actually negotiate for any of them. So Phil can't negotiate with CVS on behalf of the PhilRx network unless they evolve and become a full fledged PSAO, which is way more complex than they are ready to handle.

    Phil's not the only program who has the business model. Look up 42 North Rx. It's the exact same thing. It's a bunch of manufacturers hopping from company to company hoping to find a way to bypass the need for prior authorizations, and companies looking for pharmacies willing to take on all the liability for them.

    If you'd like me to send you the "working with Phil" powerpoint hype machine I was sent as well to prove that I do in fact know what I'm talking about, I'll happily do that as well. It's really weird to me that you're trying to sell them as this pharmacy oasis of the future, and when I refuted that idea, you combined both "I don't think you're right" with "I don't know much about their business model" - I don't understand why you're trying to vehemently defend this business model against my criticism if you don't actually know how they work.
     
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  25. owlegrad

    owlegrad Uncontrollable Sarcasm Machine
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    I don't understand what you mean by this. Doesn't every pharmacy "take on all the liability" every time they fill a script? It seems like this 'Phil' thing is just another way for independents to be sent scripts? Where exactly is all this extra liability coming from vs just billing a claim the traditional way?
     
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  26. CynicalIntern

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    In a normal business model where you're comparing Fred's Rx vs. Smith's apothecary, you're absolutely right. But like I said before, Phil is not actually doing much of anything. They're acting as a hub to accumulate data, collecting the data, and sending the dirty work to the pharmacies to be taken care of. Which is fine if the pharmacy is just getting the prescription sent to them and gets to fill it and collect whatever marginal profit comes from the script. But if the addendum to the Caremark manual works as expected, Caremark is going to come after these pharmacies for whatever funds they were paid for these (probably $600 drugs), not to Phil, because they did not pay a dime to Phil. So now you're liable for a prescription that you acted as a hub for, that you actually are paying for the right to receive (because of course you pay Phil for their software) and Phil is defending it as "CVS can't do that" when CVS is, in fact, doing that.

    It is, of course, all speculative, because right now the only people that Caremark has come after are those who are using manufacturer copays for non-FDA approved products and medical foods (which is terrifying, because I've never even considered that as a possibility). But the benefits are far, far outweighed by the risks.
     
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  27. JamesL1585

    JamesL1585 TheAntiSavior?
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    Thank you for sending this, it makes so much more sense. Really appreciate that (most people wouldn't).

    My optimism comes because I understand "pivoting" and how you must do so to appeal to your customers, your partners, and otherwise. If you can't create value and incentives for all parties, then you don't have a business and you're destined to fail. I'm in good faith saying that this is the approach Phil will take, obviously, I could be wrong. I'm hoping I'm right though and they learn to create value for patients, and pharmacy partners.
     
    Riskybusiness likes this.
  28. wagrxm2000

    wagrxm2000 Do not respond to this
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    Still see no use to Phil. My gut says either their plan the entire time is to get bought out and make a ton of money (most likely outcome) or they won't make it but the owners will have taken so much money out of the business they will end up doing well for themselves and just move on to their next idea.

    Either way this company is to make money and not to help independents.
     
  29. Riskybusiness

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    I found a space lease was signed keys handed over on Friday. I found an amazing space at a very affordable price. Owners did not want another nail salon lease.

    Buildout started this weekend. I recruited the help of friends and family. I was very fortunate they all come out this weekend. Things were rough. Walls removed, drywall hung, electrical lines ran and tons of other things were done. Lots of pizza and beers consumed. A small amount of work remains. I will be continuing every night this week. A 1-week buildout that cost under $1000 almost hard to imagine. Every single attempt at saving money was used. Studs pulled from walls were cut down into trim. Doors were recycled from a nearby house flipper. The carpet was able to be saved. Everything is looking proper. Shelving, counters, and workstations remain.



    Making a list of things to buy

    Pharmacy software, computers, POS system, Delivery management
    Labels
    Bags
    Vials
    Have to search apothecary products catalog
    the scale does anyone use a torsion balance??? can I skip to a digital one?






    A few things I would prefer not to become a thread killer.

    Phil looks interesting. I don't have the ability to concentrate on that currently.

    I am not trying to underpay a pharmacist or seek out cheap labor. I own another business and have never underpaid any employee. I actually overpay my current employes and will continue to do so. An employee represents everything you do as a company. I expect a high level of customer service and try to mimic hospitality industry standards to health care. Good employees will be well paid and groomed into top-quality professionals. Bad employees will be given an opportunity to learn or they will no longer be employed by myself.
     
  30. wagrxm2000

    wagrxm2000 Do not respond to this
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    What do you plan on paying your pharmacist?
     
  31. eeyore spice

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    Frankly, this sounds like my dream job, literally building a pharmacy from the ground up. And you know you're going to have a loyal employee if they're willing to actually do heavy lifting!
     
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  32. CetiAlphaFive

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    Strange, but interesting
     
  33. PharmDBro2017

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    Props to you. Will continue to follow along. Keep doing your thing dude, stay positive.
     
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  34. OXYFORALL

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    Winrx is great software to work with BTW.
     
  35. Pharmd77:)

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    So the copay cards have to come from the providers location only now? A patient can't go to the manufacturer website and get a copay card, even though it says you can on their website?
     
  36. ExpressMaiL

    ExpressMaiL alea iacta est
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    I've opened 3 from scratch and acquired an existing one. Building them out is substantially cheaper than acquiring licensed operations. Know that many pharmacy catalogs out there are taking advantage of "entrepreneurs" with unbelievably high prices for simple pharmacy items.

    Also, I have used compounding equipment for sale. Where are you located?
     
  37. ImmunoglobulinE

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    awesome job so far. I would be following your foot step in a year or two.

    on the average how much upfront cost to start a mid size pharmacy?
     
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  38. rockpharm

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    If you want to talk, I just opened a pharmacy a little over 3 years ago. PM me.
     
  39. ExpressMaiL

    ExpressMaiL alea iacta est
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    There is no average cost, it depends on what you're starting from, what your plans are and how much work there is.
     
  40. southpharmindy

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    Listen to ExpressMail. I'd never buy anything "new". I buy all of my computers, scanners, thermal printers, etc. refurbished on Ebay for a fraction of the cost of a new one. When they break I throw them away and buy a new one.

    I've never opened a pharmacy from scratch but I talked to a guy on another forum that did. Very smart guy by the way. He said that his biggest mistake was ordering too many drugs up front. The wholesalers will try to sell you $150,000 worth of drugs up front. You don't need it. Start with 5-10k worth of drugs and order them as the transfers come in; most new customers will understand if you have to order their drugs the first time the come to your pharmacy.
     
  41. rph3664

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    My BFF works for an independent in a small city that has a medium-sized college. It's been in the same location for many years, and so have the employees; at 55, he's actually the youngest FT pharmacist. He loves it! He isn't paid anywhere near as much as he was at Walgreens, and the benefits aren't that good, but he doesn't have to deal with metrics, flu shot quotas, district managers, etc. They stay afloat with a nursing home contract, and they are the 340B outlet for their county; most of the clientele are people with severe mental illnesses who get things like monthly Risperdal injections, and they are ordered through this store.

    A Walgreens pharmacist in my city who was about our age died recently. The obituary didn't say why, but I couldn't help but think that the job killed her. :(
     
  42. NattyBuilderRX

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    Respect your courage to open your own store! Wish you the best! I'm looking to open my own independent as well.
     
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  43. rph3664

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    Earlier this week, I had a long-overdue dental cleaning, and told the hygienist about flu shot quotas. Her reaction was basically :wtf: .
     
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  44. BidingMyTime

    BidingMyTime Lost Shaker Of Salt
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    Just don't do anything illegal. This was before your time, but there was another poster here who opened his own pharmacy and kept us updated on how things were going for several years.....then he was arrested for major insurance fraud-and hasn't come back to update us anymore. :(
    So keep on the straight and narrow.
     
  45. VictorOfHungerGames

    VictorOfHungerGames May the odds be ever in your favor

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    Explain... do you know what kind of insurance fraud or what happened?
     
  46. Riskybusiness

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    Been absolutely crazy busy working on everything. So far I made real progress.

    I made the Board of Pharmacy meeting and they approved me for opening a new store.

    I hustled down the very overworked and overbooked board inspector who was very nice and squeezed me in. Passed with flying colors. They are very nice to you if you are prepared with organized paperwork and copies ready to go.

    Still trying to stay on a tight budget and control costs where I can. Still under 10 grand so far
    I ended up buying a few things needed for opening.
    a few new things
    The computer system was the trade show special from rx30
    custom labels from drug package( should have avoided this spend)
    Vials 21 a case Chinese knockoff's of Kerr
    A licensed architect was not cheap 1,500$$
    used purchases
    Torsion balance and weight (eBay score)
    everything new or used on eBay or Amazon
    beakers flasks titration plate spatulas.
    I self-made a policy and procedure manual to follow my state boards requirements.

    So my state drug store permit and controlled numbers have been issues

    Now the wait for DEA registration which you can not apply for until you have been issued state permits.

    Part 2
    Selecting a wholesaler and PSAO combo
    anyone on here use Smartfill ??

    Front store. Looking to fill a very small front store. Looking for more of a boutique feel to it. I can not compete with chain store front ends. Was going to carry Goats milk skin care, CBD products, Small greeting card spinner. Any connections to these products or wholesalers
    I will post a few pictures later of my build out and space.
     
    #45 Riskybusiness, Nov 12, 2018 at 6:44 PM
    Last edited: Nov 12, 2018 at 7:14 PM
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  47. Riskybusiness

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    No worries here. I am more afraid of an insurance audit where they pull something stupid.
     
  48. Riskybusiness

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    One of the best posts here. Opening inventory deals sound nice but you always pay somewhere. Everyone absolutely everyone has a hand in retail pharmacy pockets.
     
  49. Riskybusiness

    Joined:
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    Pm me your email
     
  50. Riskybusiness

    Joined:
    Sep 26, 2018
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    pm me your email

    The biggest killer I found is the initial buying group they offer startups. I did a price comparison and they are killing startups. They offer free consulting from someone who probably knows less than we would know about our market.
     

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