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| When we receive the following
information, we can determine a free pharmacy valuation for your
business, using our quick analysis process. All data is kept confidential and is not shared with any other company. Easily provide your
pharmacy business
valuation information directly
to us by completing the web form and clicking the Submit Button below,
or contact: |
| Owners Name: | |
| Business Name: | |
Business
Location Address: |
|
| Street: | |
| City, State, Zip: | |
| E-Mail: | |
| Business Mailing Address: | |
| Street: | |
| City, State, Zip | |
| E-Mail: |
| 1. Contact Information: |
| Work Phone:
|
Work Fax:
|
Work E-Mail
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| Home Phone:
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Home Fax:
|
Home E-Mail
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| Cell Phone:
|
| 2. Business History: |
| Year Established: | Year Purchased: |
| Comments:
|
| 3. Personnel: | Full Time: | Part Time: |
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Number of: Pharmacists: |
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Techs: |
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Clerks: |
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Delivery: |
||
| Office: | ||
| Other: |
| 4. Delivery Service: |
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Provide Delivery Service? |
Yes | No |
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How Many Per Day? |
Per Week? |
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Farthest Distance in Miles? |
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| 5. Location: | |
| Square Footage? | Age of building? | City Population? |
| Type of location: | ||
| Medical Building: |
|
Shopping Center: |
|
Strip Mall: |
Stand Alone: |
Other: |
|
Drive up Window? |
Yes: | No: |
| Describe neighborhood: | ||
|
Suburban: |
Downtown: | Rural: |
| Income level of neighborhood: | ||
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Low: |
Medium: | High: |
| Describe competition within 1 1/2 miles: |
| 6. Leased Location: |
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Rent Payment: $ |
Years remaining on lease: |
|
Any options on lease? Yes: |
No: |
| 7. Owned Location Property: | |
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Value of property: |
$ |
|
Principal amount owed on property: |
$ |
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Mortgage Payment: |
$ |
| 8. Value of Assets: | |
| Book value of furniture and fixtures: | $ |
| Any new computers or point of sale equipment: | Yes: No: |
| Current inventory at cost: | $ |
| Total 3rd party and private monthly A/R: | $ |
|
9. Annual Sales: |
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| Total Sales: | $ |
| Prescription Sales: | $ |
| Front Sales: | $ |
| Durable Medical Equipment (DME): | $ |
| Compounding: | $ |
| Special Services: | $ |
|
10. Third Party Sales: |
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| Medicare: | $ |
| Medicaid: | $ |
| Contract: jails, health care facilities, etc: | $ |
| Private insurance/Group insurance: | $ |
| Percentage insurance sales: | % |
| Percentage cash sales: | % |
| 11. Weekly Prescription Sales: | |
| Prescription sales: | $ |
| Number of prescriptions filled: | # |
| Percentage of "New" Rx sales: | % |
| Percentage of "Refill" Rx sales: | % |
| Average price of a Rx sale: | $ |
| 12. Seller Employment: | |
| Is the seller willing to work for the buyer? | Yes: No: |
| How long? | |
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13. Other: |
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| I am considering selling my pharmacy, but I am not serious at this point. |
Yes: No: |
| I am definitely looking to sell my pharmacy. | Yes: No: |
| I am not looking to sell my pharmacy. |
Yes: No: |
| I need to know the value of my pharmacy due to divorce, or other legal matter. | Yes: No: |
| 14. Additional Comments for Geof at SellBuyPharmacy: |
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Copyright [2002-2010] Washburn & Associates |