Washburn & Associates ~ Free Pharmacy Valuation

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.

After completing the form, you may:

Print the form using your browser's print button and then fax the information to: Geof at: 636-493-2222 , or
Submit the form directly to us buy using the Submit Button below, or
Email the form to Geof@SellBuyPharmacy.com, or
Call us at 636-946-1116.

We will be happy to supply you with a valuation at no cost or obligation.

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

Home Phone:

Home Fax:

Home E-Mail

Cell Phone:

2. Business History:

Year Established:

Year Purchased:

Comments:

3. Personnel:	Full Time:	Part Time:
Number of: Pharmacists:
Techs:
Clerks:
Delivery:
Office:
Other:

4. Delivery Service:

Yes

Provide Delivery Service?
How Many Per Day?	Per Week?

Farthest Distance in Miles?
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:
Low:	Medium:	High:

Describe competition within 1 1/2 miles:

6. Leased Location:

Rent Payment: $	Years remaining on lease:
Any options on lease? Yes:	No:
7. Owned Location Property:
Value of property:	$
Principal amount owed on property:	$
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:
Total Sales:	$
Prescription Sales:	$
Front Sales:	$
Durable Medical Equipment (DME):	$
Compounding:	$
Special Services:	$
10. Third Party Sales:
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?

13. Other:
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. I need to know the value of my pharmacy due to divorce, or other legal matter.	Yes: No:

14. Additional Comments:

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