Please fax or email the completed form along with your purchase record or invoice supporting acquisition cost and alternate NDC information to:
Myers and Stauffer Maryland Help Desk: Fax: 317-571-8481, Email: firstname.lastname@example.org. Forms submitted without purchase record or invoice supporting your acquisition cost will not be considered for review. Once complete information is received, we will evaluate your inquiry and respond within 48 business hours. For questions or to check the status of an inquiry please contact us by email at email@example.com or by phone at 800-591-1183.