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 | ATTENTION!
Alliance
Medical, Inc. must have on file written authorization from the
physician acting as Medical Director for your service (or the
responsible physician at your place of business) for us to be able to
ship you any pharmaceuticals and legend products.
Please download our form, fill it out and return a signed copy to us via fax or mail.
(Please note that you will need adobe acrobat reader in order to view this form, you may download a copy free here
If
your organization is licensed to purchase prescription drugs but does
not have a Medical Director, please send a copy of your license along
with our form.
Thank You,
Alliance Medical, Inc
P.O. Box 147
Russellville, MO 65074
Fax: 1-800-4ALLMED (1-800-425-5633) |
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