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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
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Address
Contact Name
Contact Email Address
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Facility
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Address
Phone Number
Facility Code
This is the code used on pharmacy bill
Administrator
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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
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