Home
Contact
Manufacturer Submission Form
New Product Submission Form

image description

New Product Submission Form

New Product Submission Form

Company Name
Contact Name(required)
Contact Phone(required)
Email(valid email required)
NDC Number
UPC Number
NHRIC
Product Name(required)
Package Size
Dosage Form
RX or OTC
Pricing Policies (PDF)
Wholesale Acquisition Cost (WAC)
Information will be provided to Gold Standard Drug Database customers
Direct Price (DP)
Information will be provided to Gold Standard Drug Database customers
Suggested Average Wholesale Price (SAWP)
Information will be provided to Gold Standard Drug Database customers
Effective Ship Date
Product Physical Description (if not provided in Package insert of label)
Please submit the following supporting documents for each new product:
Package Insert
Package Label
FDA Approval Letter (NDA, ANDA, BLA) if applicable
Product Image or Product Example

cforms contact form by delicious:days