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CareRx Health Solutions
Master Registration & Affiliate Authorization Agreement

Purpose
This Master Registration & Affiliate Authorization Agreement is entered into between CareRx Health Solutions and the undersigned Clinic/Practice ("Clinic"). By signing this Agreement, the Clinic authorizes CareRx to establish accounts with CareRx and its affiliated pharmacies, distributors, manufacturers, fulfillment providers, and strategic healthcare partners as necessary to facilitate ordering and fulfillment of products and services.

1. Non-Exclusive Relationship
This Agreement is non-exclusive. The Clinic may purchase from any supplier. CareRx may utilize affiliated partners based on availability, licensure, geography, regulatory requirements, pricing, inventory, or operational needs.

2. Affiliate Registration Authorization
The Clinic authorizes CareRx to register the Clinic with affiliated partners, submit registration documentation, share necessary business information, and establish purchasing accounts. Registration does not obligate the Clinic to purchase from any affiliate.

3. Information Sharing Authorization
The Clinic authorizes CareRx to share clinic information, contact information, prescriber names, NPI numbers, supervising physician information, DEA (if applicable), licenses, tax ID, and other documents reasonably required for account setup and compliance.

4. Ordering Authorization
Once approved, the Clinic may order products through affiliated partners. Product availability, pricing, and shipping policies may vary by partner.

5. Compliance
The Clinic certifies all prescribers maintain appropriate licensure and agrees to comply with all applicable federal and state laws.

6. Independent Companies
CareRx Health Solutions and each affiliated partner remain independent entities responsible for their own manufacturing, dispensing, shipping, billing, and regulatory compliance.

7. Future Affiliates
This authorization automatically extends to future affiliated partners unless revoked in writing by the Clinic.

8. Term and Revocation
This Agreement remains in effect until revoked in writing. Existing orders and obligations remain enforceable.

9. Electronic Signatures
Electronic and scanned signatures are considered legally binding.

By signing, the Clinic acknowledges that it has read, understands, and agrees to the terms of this Agreement.

Clinic Name

Provider Name

NPI Number

Email Address

Phone Number

Upload Licenses/Certifications

Clinic Address

Supervising Physician Name

Supervising Physician NPI

Areas of Interest

Clinic Contact Signature

Sign here