PPO

Purchase Order Form

PROVIDER PROCUREMENT NOTICE

APX operates solely as a procurement coordination service for licensed providers and authorized practice purchasers.
Products accessed through this purchase order are for professional procurement only.
APX does not prescribe, dispense, compound, manufacture, or provide medical advice.
The purchasing provider or authorized practice representative assumes responsibility for all professional, clinical, and regulatory decisions related to product use.

Company Information

Company Name^*

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Contact Name^*

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Street Address^*

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State^*

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City^*

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Zip Code^*

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Phone^*

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Email^*

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NPI/Medical License^*

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DEA License (If Applicable)

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EIN

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Medical State License

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PRODUCT USE & RESPONSIBILITY ACKNOWLEDGMENT

Products made available through this procurement channel are acquired at the discretion of the purchasing provider or authorized practice representative. Unless expressly fulfilled through a licensed pharmacy, products listed on this page are not represented by APX as compounded prescription medications dispensed to a patient.
APX makes no representation regarding therapeutic outcomes, patient suitability, or clinical efficacy.
All use, handling, storage, administration, and compliance obligations remain solely with the purchasing practice and supervising provider.

Shipping Address

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State^*

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City^*

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Zip Code^*

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Purchase Order

Peptides Products

Select All

Peptide Montana

BPC 157 10mg

$21

Semax 10mg

$17

Selank 10mg

$17

SS31 10mg

$22

MotsC 40mg

$49

KPV 10mg

$21

NAD+ 100mg

$46

TB 500 10mg

$29

Purchase Order Total

Terms: Payment is due immediately upon recipt of the invoice

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