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: 719-576-3586, or
Submit the form directly to us buy using the Submit Button below, or
Email the form to BradPharmacy@msn.com, or
Call us at 719-576-3584.

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 No

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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