RxReconn Subscription Form By becoming a member of NCPDP for $750.00 you will be eligible to receive RxReconn® at $2,800 annually! Complete the form below with the "Add RxReconn® to your Membership" button clicked to begin enjoying both your subscription and membership today! The annual, individual NCPDP membership fee is $750.00, payable by credit card or check in U.S. funds drawn on U.S. banks and members receive RxReconn for a discounted price so your membership pays for itself! Note: Looking to apply for a NCPDP number or to access your NCPDP pharmacy profile? Please go to https://accessonline.ncpdp.org or call 480.734.2870. Download Membership Application Prefix Mr. Ms. Dr. Mrs. * * Suffix Jr.. Sr. Esq. R.Ph. J.D. M.D. M.B.A. Pharm. D. Company Information * * Country UNITED STATES AFGHANISTAN ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOWINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRITISH VIRGIN ISLANDS BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS ISLANDS COLOMBIA COMOROS CONGO CONGO THE DRC COOK ISLANDS COSTA RICA COTE DIVOIRE CROATIA Hrvatska CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC EAST TIMOR ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS FAROE ISLANDS FIJI FINLAND FRANCE FRANCE METROPOLITAN FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUINEA GUINEA-BISSAU GUYANA HAITI HEARD AND MC DONALD ISLANDS HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA D.P.R.O. KOREA,REPUBLIC OF KUWAIT KYRGYZSTAN LAOS LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAU MACEDONIA MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT KITTS AND NEVIS SAINT LUCIA SAINT VINCENT AND THE GRENADINES SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND SOUTH S.S. SOUTH SUDAN SPAIN SRI LANKA ST. HELENA ST. PIERRE AND MIQUELON SUDAN SURINAME SVALBARD AND JAN MAYEN ISLANDS SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN,PROVINCE OF CHINA TAJIKISTAN TANZANIA,UNITED REPUBLIC OF THAILAND TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM URUGUAY UZBEKISTAN VANUATU VATICAN CITY STATE VENEZUELA VIET NAM WALLIS AND FUTUNA ISLANDS WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE * * State/Province * * Use for billing address Contact Information * * * Example: 9999999999 Professional Information Professional Level Academic CEO/COO/CFO/Partner CIO Director/Department Head Other Senior Management Practicing Pharmacist President Senior Staff/Manager Staff Vice President * Job Function Information Systems Maintenance/Support Operations Other Project Management Purchasing/Contract Regulatory/Compliance Research/Development Sales/Marketing Technical Services * Reason for Joining First Join Reason Company recognition in industry Annual conference attendance Work group participation and standards influence Membership directory acquisition Educational Program attendance Networking opportunities Personal/Career Advancement Standards documentation acquisition Databases and RxReconn Access Database Products Certification Program Other * Second Join Reason Company recognition in industry Annual conference attendance Work group participation and standards influence Membership directory acquisition Educational Program attendance Networking opportunities Personal/Career Advancement Standards documentation acquisition Databases and RxReconn Access Database Products Certification Program Other Membership Class Main Classes Payer/Processor Producer/Provider Vendor/General Interest * Subclass Producer/Provider Academic Health Center Clincial/MTM/Formulary Mgt Org. Clinical/MTM/Formulary Mgmt Org Compounding Pharmacy Consultant Pharmacist Services Consulting to Producer/Provider Hospice Pharmacy Hospital Pharmacy Inpatient Care Center Long Term Care Pharmacy Mail Service Pharmacy Medical Equipment/Supplies Other Producer/Provider Other_ Outpatient Care Center Pharmaceutical Manufacturer Pharmacy Services Admin Org (PSAO) Physician Dispensing Entity Physician Services Organization Prescription Consulting Entity Retail Pharmacy Specialty/Home Infusion Pharmacy Subclass Payer/Processor Accountable Care Organization (ACO) Accountable Care Organizations (ACO) Consulting to Payer/Processor Federal/State Agency Fiscal Agent/Intermediary Health Insurer Health Maintenance Organization Health Plan Sponsor Managed Care Organization Medication Therapy Mgmt Admin Medication Therapy Mgt. Admin. Other Other Payer/Processor Pharmacy Benefit Management/Admin Company Pharmacy Benefit Mgmt/Admin Company Transaction Processor (Rebates/Coupons) Worker’s Comp Organization Worker's Comp Organization Subclass Vendor/General Interest Academia/Research Foundation Automation/Robotics Clearinghouse Clinical Programs Consulting - General Consulting – General Data Mgmt Vendor or Integrator Data Mgt Vendor or Integrator Distribution/Packaging Drug Information Resource Company EHR/PHR Vendor Equipment/Product Supplier Federal/State Agency (non-payer) Health Info Exchange/HIE/Intermediary Health Information Exchange/HIE Vendor/Intermediary Informatics/Data Analysis Law Firm/Legal Services Marketing/Educational Services Network/Contract Management Other Other Vendor/General Interest Professional Services Professional Trade Association Professional/Trade Association Software Vendor/Certifier System Vendor Wholesale Drug Distr/Repackager Wholesale Drug Distributor/Repackager Subclasses * How did you hear about us? Add RxReconn to your Membership (Member Price: $2,200 per year)No, Thanks. Continue without RxReconn Not sure? Learn More * Memberships are nonrefundable, but may be transferred from one individual to another one time in each anniversary year. There is a $100 USD processing fee for the transfer. Whoever pays for the membership owns it. If your company pays for an individual membership for you, the company may transfer the membership to another individual within your company. If you pay for your individual membership, the membership may move with you if you change jobs. NCPDP Foundation is a 501(c)(3) nonprofit charitable organization headquartered in Scottsdale, Arizona, and is affiliated with the National Council for Prescription Drug Programs (NCPDP). Approved by the NCPDP Board of Trustees, the Foundation was established in December 2012 to support research, education and charitable involvement within the healthcare industry. To learn more, visit http://ncpdpfoundation.org, email email@example.com or call 480.477.1000 ext. 131.