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Provider Account Agreement
For healthcare professionals seeking a streamlined process for billing and medication orders, we invite you to follow the link below to complete the Account Agreement form. This form is designed to establish a comprehensive billing account with us, ensuring a seamless collaboration. Please provide the required details, including physician name, clinic name, DEA number, license number, NPI number, and billing information.
After completing the form, it will be automatically submitted for processing.
Any questions please contact us at info@ucprx.com
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