Registration

I am a new Hikma 503B customer

My facility is a Hikma 503B customer, but I need to create a username.

I already have a login and want to add another account to my profile

Please email your facility list to mail img [email protected] to get started. We will walk you through next steps.

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* All fields required

First Name *

Last Name *

Title *

Phone *

Email *

Account Number *

Facility Name *

Facility DEA Number *

Create Password *

Confirm Password *

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* All fields required

Attention To *

Facility Name *

Street Address 1 *

Street Address 2

City *

State *

Zip *

GLN (Global Location Number) Ship To

DSCSA (Drug Supply Chain Security Act) Contact

First Name

Last Name

Job Title

Phone

Hikma Sales Representative Name *

I do not have a Hikma Sales Representative

Facility DEA Number *

My facility does not have a DEA License

Upload applicable State & DEA licenses here: *

Click to Browse or Drag & Drop document files here

GPO Affiliation

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Account Number *

* All fields required

Legal Business Name *

Street Address 1 *

Street Address 2

City *

State *

Zip *

GLN (Global Location Number) Bill To

D-U-N-S® Number *

My facility does not have a D-U-N-S® Number

Federal Tax ID

Requested Credit Limit

Do you accept the Terms and Conditions for Credit? *
Yes
No

Bank & Trade References

Click to Browse or Drag & Drop document files here

Denial Reason *

Accounts Payable Phone Number *

Accounts Payable Email *

Hikma strives for paperless invoicing.

What are your invoicing requirements?

Email only Mail only Both Mail & Email are Required

For emailed invoices, please provide email addresses that should be included: *

Please drag and drop any required files you have related to invoicing (EDI instructions, portal information, etc.):

Click to Browse or Drag & Drop document files here

Additional notes:

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All distributers of controlled substances are required by the United States Drug Enforcement Administration (DEA) to "know our customers" per the Controlled Substances Act and 21 CFR 1301.74 (b)). In response to the DEA requirements, Hikma Pharmaceuticals USA Inc. (Hikma) has implemented a Due Diligence Program to "know our customers."

Hikma has a separate controlled substance purchase questionnaire through a 3rd party vendor called Navex. Completion of the questionnaire is required to purchase controlled substances.

The questionnaire should be completed in its entirety and signed by the responsible party who holds the DEA registration or by power of attorney as authority to sign for that DEA registration.

Please provide the appropriate individual's contact information below. The questionnaire will be sent via email in 24-48 hours.

* All fields required

First Name *

Last Name *

Job Title *

Phone *

Email *

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Submit

You will receive an email shortly confirming receipt of your submission. Hikma 503B Customer Service will contact you once your account has been finalized.

In the meantime should you have any questions please do not hesitate to reach out to your account manager or our Customer Service Team:

call img 1.800.631.2174

[email protected]

calender img Click here to schedule a meeting with our team

Remove additional user

First Name *

Last Name *

Title *

Phone *

Email * (this will also be your user name)

Create Password *

Confirm Password *

I am an authorized CSOS signer

Add additional user

Welcome to Hikma, We appreciate the opportunity to partner with you!
Your account has been registered and has been sent for review and approval as a commercial account. You will be receiving confirmation shortly.

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Welcome to Hikma, We appreciate the opportunity to partner with you!
Your account has been registered and has been sent for review and approval as a retail account. You will be receiving confirmation shortly.

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