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Complete the form below to generate your free E-Prescribing Activity Report

Thank you for your interest in electronic prescribing. The first step is to confirm that your pharmacy management software system has been certified to connect to the Surescripts network.

After completing the form below, you will be able to view a customized e-prescribing activity report that includes the names of prescribers who are actively e-prescribing in your area as well as the certification status of your pharmacy management software vendor and next steps for enabling your e-prescribing capability.


First Name:
Last Name:
Pharmacy Name:
NCPDP ID:
Email:  
Telephone:
Fax:
Address:
City:
State:  
Zip Code:  
Pharmacy Software Vendor Name:  
Other (Please Specify):
Function:
How would you prefer to receive future communications from Surescripts?
Mile Radius Preference:





Note: if your pharmacy is already enabled for e-prescribing and you are seeking
technical support, contact your pharmacy software vendor or call Surescripts support at 1-866-RxReady.