Surescripts
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First Name*
Last Name*
Job Title*
Company Name*
Which best describes your business?*
Who is your EHR vendor?*
Who is your pharmacy software vendor?*
Do you have an established U.S. legal entity?*
Company Website URL*
Phone Number*
Products of Interest*
Care Event Notifications
Clinical Direct Messaging
E-Prescribing
Electronic Benefit Verification
Electronic Prior Authorization
Eligibility
Formulary
Medication History for Ambulatory
Medication History for Populations
Medication History for Reconciliation
Medication Request
Real-Time Prescription Benefit
Record Locator & Exchange
Therapeutic Alternatives
Touchless Prior Authorization
Who is your customer as it relates to potential interactions with Surescripts?*
Health Plan
Independent Pharmacy / Retail Pharmacy / DTC Pharmacy
Patient / Consumer
Patient Access Vendors
Pharma Manufacturer / Life Sciences
Physician / Physician Practice / Hospital / Health System
Technology Platform / Software Vendor
Tell us more about what you'd like to accomplish with Surescripts.* Please do not submit Protected Health Information via this form.
Connect with our sales team and see how Surescripts can help you inform and accelerate decisions to keep patient care on track.
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Surescripts Helath Information Network
Interested in tapping into TEFCA™ via a Qualified Health Information Network®? Learn how with Interconnect.