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New Customer Application

If you are a new customer, please fill out all required sections and submit.    For any questions, please contact us for help. 

Entity Type
Clinic
Hospital
Physician's Office
Pharmacy
Midwife
Other
Is the Bill-to-Address the same as the shipping address?
Yes
No
Are you a part of any Group Purchasing Programs? (GPO)
Yes
No

I declare under the penalty of perjury that the foregoing information is true and correct.

HPSRx Enterprises

Contact: HPSRx

Phone: (800) 850-1657 ~ (540) 375-9380

customerservice@hpsrx.com ~ www.HPSRx.com

Fax: (800) 361-6984 ~ 1640 Roanoke Blvd Salem, VA 24153

Business Hours: 9am-6pm Mon-Thurs, 9am-5:30pm Friday 

HIDA Membership

© 2025 by HPSRx.com

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