Please indicate:
New Company Information
Updated Company Information
Company Name
*
First Name
*
Last Name
*
Contact Phone
*
Contact Email
*
NDC Number:
UPC Number:
NHRIC Number:
Product Name:
*
Package Size:
*
Dosage Form:
RX or OTC:
Brand or Generic:
*
Brand
Generic
Inner Package Unit Price
*
Please add the inner package unique identifier number and specify if it SHOULD BE linked to outer package identifier for pricing or Please add the inner package unique identifier number and specify if it SHOULD NOT BE linked to outer package identifier for pricing
Federal Excise Tax Per Unit of Sale
*
Wholesale Acquisition Cost (WAC):*
*
Direct Price (DP):*
*
Suggested Average Wholesale Price (SAWP):*
*
Effective Ship Date
Effective Price Date
Product Physical Description (if not provided in package insert of label):
Package Insert
Package Label
FDA Approval Letter
(NDA, ANDA, BLA) if applicable
Product Image or Product Example
Submit to Celeste Hunter by email at
productinfo@elsevier.com
*Individual contact information (name, phone number, email address) is for Elsevier use only, and will not be published to our customers.
** For more information, refer to :
Gold Standard Drug Database Pricing Policies
Submit