Washburn & Associates ~ Specialty 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

Retail Deliveries

    

How Many Per Day?

             Per Week?

Average distance of deliveries

miles
Institutional: Jails, LTC, HC, etc           Yes     No  

How Many Per Day?

          Per Week?

Average distance of deliveries miles
5.  Location:
 Retail location   Closed door operation
Total sq ft Retail sq ft Lab sq ft
Front End sq ft  Age of building?  City Population? 

Type of location:

 Strip Mall:    Shopping Center:

 

Stand Alone  Medical Building 
  Office Warehouse  Other

Drive up Window?  Yes:  

        No:   
Describe store's neighborhood:

Suburban:

Downtown: Rural: 
Income level of store's neighborhood:

Low: 

Medium:  High: 
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: 

Comments about lease, landlord, or location:
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:  $
Number of insurance carriers:

9.  Annual Sales:
Total Sales:  $
EBITDA (Earnings Before Interest Taxes Depreciation Amortization): $
Front Sales: $

Describe Specialty:

Percentage of Rx sales and gross profit:

 
Retail:             % GP %    Mail Order: % GP %
Compounding: % GP %     Unit Dose:   %

GP %
Diabetic:         % GP %     HIV:          %

GP %
Infusion:         % GP %     DME:         %

GP %
Disease Mgt:   % GP %     Other:       % GP %

10.  Third Party Sales:

Medicare: $

 Percent of sales: % 

Medicaid: $

Percent of sales: % 

Contract: jails, health care facilities, etc: $

 Percent of sales: % 

     Average Contract Period :

Insurance:  $

 Percent of sales: % 

Cash sales: $

 Percent of 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.  Is the seller willing to work for the buyer?       Yes:        No:   
  How long?
 

13. Reason for Valuation:
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 looking for a partner or want to buy out my current partner

14.  Additional Comments for Brad at Buying And Selling Pharmacies

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