Prescription window for females of childbearing potential is 7 days beginning with the date of the pregnancy test specimen collection. Prescription window for females not of childbearing potential and males is 30 days beginning with date of the office visit.

Pharmacy Registration

Please provide your pharmacy’s NCPDP number and click the Lookup Info button. This will be used as your Username to identify you in the program and for you to login to the iPLEDGE system using the phone or internet site.

NCPDP Number 

Enter or confirm your information


* denotes required field
Responsible Site Pharmacist First Name * Responsible Site Pharmacist Last Name*
Responsible Site Pharmacist License *
Phone  Fax
Email 
Preferred Method of Communication*

Provider Information

Provider
Provider ID

Click the Save and Print button below. This will present a print friendly registration form for your signature. After printing and signing, return the form to the address or fax number found on the form.