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Prescription Only Medicines Authorisation Form (FORM-111.1)

Pharmaceutical authorisation

Prescription-only medicines authorisation

ProCure Health Limited, as a Licensed Pharmaceutical Wholesaler, is only able to supply Prescription Only Medicines to Registered Addresses in response to an order.

Prescription Only Medicines and Pharmacy products will only be delivered to the address/es listed on this form if verified.

Have these ready

Your Medical Supermarket account number
Billing and registered addresses
Your inspectorate body (e.g. CQC)
Your location ID, if you know it

Complete the formTakes about two minutes.

We verify your addressChecked against your inspectorate registration.

Order with confidenceApproved addresses are set up on your account.

Branch surgeries: add every site you want POMs delivered to. We can only deliver to addresses listed and verified on this form.

General

* This information is required.

Need a hand with this form?Our team can help you complete it, Monday to Friday, 9am to 5pm.

Call 020 3301 6500 Email help@