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Get and Sign  Samples 2019 Form

Get and Sign Samples 2019 Form

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Limited due to availability and/or at the discretion of Metuchen Pharmaceuticals. Anticipated delivery time is 5 -10 business days. Instructions: To receive the sample product you must be a licensed practitioner with a valid state license number who can legally prescribe in your state. Follow these instructions to place your request for samples. Please note that requested drug samples cannot be shipped to you if any information is missing from this form. 1. 2. 3. Confirm that your full name,...
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