Sign in here or Register to get started with your order:


Download PDF Order Online

All Other States

1-Part Pads (100 Scripts per Pad)
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
Plain Paper - Portrait Orientation: 4.25" x 5.5" $39.00 $52.00 $62.00 $76.00 $88.00 $96.00 $135.00
Tamper Resistant - (Approved for all Medicaid scripts) Portrait Orientation: 4.25" x 5.5" $48.00 $66.00 $79.00 $96.00 $115.00 $134.00 $169.00
Sched. II CS-Compliant (CA Only) Landscape Orientation: 5.5"x 4.25" $43.20 $69.80 $81.60 $98.20 $118.00 $134.40 $187.20
Sched. II CS-Compliant (WA / ME / IN / KY / WY) Landscape Orientation: 5.5"x 4.25" $53.00 $73.00 $87.00 $106.00 $127.00 $148.00 $188.00
CA Multi-Drug Portrait Orientation: 4.25"x 7" $84.00 $144.00 $180.00 $224.00 $256.00 $286.00
Add: Ground Shipping $13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
Optional Add:
Sequential Numbers starts at 000001
$10.20 $13.60 $20.40 $30.60 $34.00 $40.80 $61.20
2-Part Pads (50 Scripts per Pad with Carbonless Duplicate)
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
Plain Paper - Portrait Orientation: 4.25" x 5.5" $49.00 $72.00 $92.00 $115.00 $137.00 $157.00 $215.00
Tamper Resistant - (Approved for all Medicaid scripts) Portrait Orientation: 4.25" x 5.5" $58.00 $84.00 $114.00 $144.00 $170.00 $192.00 $249.00
Sched. II CS-Compliant (CA Only) Landscape Orientation: 5.5"x 4.25" $46.40 $76.80 $91.20 $113.60 $138.00 $165.00 $205.20
Sched. II CS-Compliant (WA / ME / IN / KY / WY) Landscape Orientation: 5.5"x 4.25" $64.00 $93.00 $125.00 $159.00 $187.00 $212.00 $274.00
CA Multi-Drug Portrait Orientation: 4.25"x 7" $96.00 $176.00 $237.60 $307.00 $382.00 $458.00
Add: Ground Shipping $13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
Optional Add:
Sequential Numbers starts at 000001
$10.20 $13.60 $20.40 $30.60 $34.00 $40.80 $61.20
Download PDF Order Online

NJ APN, PA, and Midwife

1-Part Pads (100 Scripts per Pad)
New Jersey
Pad Type
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
Advanced Practice Nurse $84.00 $114.00 $152.00 $187.00 $215.00 $250.00 $370.00
Certified Nurse Midwife $84.00 $114.00 $152.00 $187.00 $215.00 $250.00 $370.00
Physician Assistant $84.00 $114.00 $152.00 $187.00 $215.00 $250.00 $370.00
UPS Ground Shippping
Secure Signature Required
$13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
2-Part Pads (50 Scripts per Pad with Carbonless Duplicate)
New Jersey
Pad Type
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
Advanced Practice Nurse $120.00 $147.00 $210.00 $275.00 $340.00 $396.00 $558.00
Certified Nurse Midwife $120.00 $147.00 $210.00 $275.00 $340.00 $396.00 $558.00
Physician Assistant $120.00 $147.00 $210.00 $275.00 $340.00 $396.00 $558.00
UPS Ground Shippping
Secure Signature Required
$13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
Download PDF Order Online

NJPB Facilities

1-Part Pads (100 Scripts per Pad)
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
NJBP - Facilities $84.00 $114.00 $152.00 $187.00 $215.00 $250.00 $370.00
UPS Ground Shippping
Secure Signature Required
$13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
2-Part Pads (50 Scripts per Pad with Carbonless Duplicate)
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
NJBP - Facilities $120.00 $147.00 $210.00 $275.00 $340.00 $396.00 $558.00
UPS Ground Shippping
Secure Signature Required
$13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
Download PDF Order Online

NJPB - MD, DO, DDS/DMD, DPM, DVM/VMD/BVSc, OPT

1-Part Pads (100 Scripts per Pad)
New Jersey
Pad Type
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
NJPB - MD, DO, DDS/DMD, DPM, DVM/VMD/BVSc, OPT $84.00 $114.00 $152.00 $187.00 $215.00 $250.00 $370.00
Optometry - Eyewear* $84.00 $114.00 $152.00 $187.00 $215.00 $250.00 $370.00
Optometry - Blank* $84.00 $114.00 $152.00 $187.00 $215.00 $250.00 $370.00
UPS Ground Shippping
Secure Signature Required
$13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
2-Part Pads (50 Scripts per Pad with Carbonless Duplicate)
New Jersey
Pad Type
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
NJPB - MD, DO, DDS/DMD, DPM, DVM/VMD/BVSc, OPT $120.00 $147.00 $210.00 $275.00 $340.00 $396.00 $558.00
Optometry - Eyewear* $120.00 $147.00 $210.00 $275.00 $340.00 $396.00 $558.00
Optometry - Blank* $120.00 $147.00 $210.00 $275.00 $340.00 $396.00 $558.00
UPS Ground Shippping
Secure Signature Required
$13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
Download PDF Order Online

All Other States Premium Security

1-Part Pads (100 Scripts per Pad)
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
Premium Security - (Meets or exceeds security requirements in all states) Landscape Orientation: 5.5" x 4.25" $57.00 $79.00 $94.00 $115.00 $138.00 $161.00 $203.00
Add: Ground Shipping $13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
Optional Add:
Sequential Numbers starts at 000001
$10.20 $13.60 $20.40 $30.60 $34.00 $40.80 $61.20
2-Part Pads (50 Scripts per Pad with Carbonless Duplicate)
8
Pads
16
Pads
24
Pads
32
Pads
40
Pads
48
Pads
72
Pads
Premium Security - (Meets or exceeds security requirements in all states) Landscape Orientation: 5.5" x 4.25" $69.00 $101.00 $137.00 $173.00 $204.00 $230.00 $299.00
Add: Ground Shipping $13.50 $14.50 $14.50 $15.00 $16.00 $16.50 $20.50
Optional Add:
Sequential Numbers starts at 000001
$10.20 $13.60 $20.40 $30.60 $34.00 $40.80 $61.20
Download PDF Order Online

EMR Laser Paper 8-1/2" x 11" NJPB MD-DO 1-up with perf

EWNJ1000
1000
Sheets
(0.4 carton)
EWNJ2500
2500
Sheets
(1 carton)
EWNJ5000
5000
Sheets
(2 carton)
EWNJ10000
10,000
Sheets
(4 carton)
Per Carton Price $144.45 $312.98 $597.10 $1,113.50
Shipping Price $15.00 $18.50 $32.00 $53.00
Download PDF Order Online

EMR Laser Paper 8-1/2" x 11" Medicaid-Compliant 1-up

EWNJ1000
1000
Sheets
(0.4 carton)
EWNJ2500
2500
Sheets
(1 carton)
EWNJ5000
5000
Sheets
(2 carton)
EWNJ10000
10,000
Sheets
(4 carton)
Per Carton Price $79.00 $169.00 $324.00 $575.00
Shipping Price
(Available to 48 contiguous states only)
$16.50 $26.00 $48.00 $92.00
Download PDF Order Online

EMR Paper 8-1/2" x 11" California CS-II 1-up

EWNJ1000
1000
Sheets
(0.4 carton)
EWNJ2500
2500
Sheets
(1 carton)
EWNJ5000
5000
Sheets
(2 carton)
EWNJ10000
10,000
Sheets
(4 carton)
Per Carton Price $125.00 $287.50 $525.00 $900.00
Shipping Price
(Available to 48 contiguous states only)
$22.00 $35.00 $66.00 $124.00
*TPA/OM Certification Number Required for Optometry NJPBs