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Medicaid Compliant Pads
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Select:
1-part 100 rx/pad
2-part 50 sets/pad
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Quantity:
5
10
20
40
60
80
120
Add logo:
Please Select
No Logo
Repeat logo
New logo. (one-time $35 setup charge, upload new file at checkout)
Order Options:
2 part RX Wraparound Cover OPTION (add $1 per pad)
* RX Numbering:
Please Select
No Numbering
First Sheet only--adds $1 per pad
2 part Rx OPTION: Number both sheets (adds $2 per pad)
Production Time:
Please Select
Standard Delivery Available
RUSH - Not available at this time
Project Name:
Multiple Names / Multiple Addresses --4.25 x 5.5 Medicaid RX Pads
This item is designed for Multiple Names / Multiple Addresses
--see other products for single name / address.
Meets CMS Tamper-Resistant Prescription Requirements
Customizable to meet your needs--
Choice of formats.
Choice of 1-part or 2-part (with carbonless copy).
Available with optional wraparound covers.
Available with sequential numbering.
Custom Designs Available--Call for Details
Institutional Discount Pricing Available--Call for Details
Price per pad based on quantity ordered:
At Checkout, please upload an Excel or Word file with the following information, as you want it to appear on the pad:
Provider Names
DEA and License Numbers
NPI Numbers
Addresses
Phone / Fax Numbers
We will upload a proof to your account for approval and send an email notification. We
MUST
receive proof approval before we can proceed with your order.