Welcome to Integra Scripts

Please fill out this form so we can provide you with outstanding service. If you have any questions when filing out this form please feel free to reach out to us at 732.965.2233 or info@integrascripts.com

Corporate

Name

Address

Contact Name

Contact Email Address

Contact Phone Number

Facility

Name

Address

Phone Number

Facility Code

This is the code used on pharmacy bill

Administrator

Name

Email Address

Phone Number

Director of Nursing

Name

Email Address

Phone Number

Regional Director (if applicable)

Name

Email Address

Phone Number

Accountants Payable

Person in the facility to contact regarding Integra Invoicing.

Name

Email Address

Phone Number