New Product Submission Online Form

Please indicate

New Company InformationUpdated Company Information

Company Name *

Nombre *

Apellidos *

Email *

Teléfono *

NDC number:

UPC number:

NHRIC Number:

Cargo

País/región

Company Address

Ciudad

Código postal

Product Name: *

Package Size: *

Dosage Form:

RX or OTC:

Brand or Generic: *

BrandGeneric

Inner Package Unit Price *

Federal Excise Tax Per Unit of Sale *

Wholesale Acquisition Cost (WAC): *

Direct Price (DP): *

Suggested Average Wholesale Price (SAWP): *

Product Physical Description (if not provided in package insert of label):

¿Que reto deseas afrontar?

WebApp_Label

WebApp_Name

Campaign_Name

Response_Type

Product 1 Level

Product 2 Level

Product 3 Level

Communication_Types

dgcid

referrerURL

submission_url

lang_code

correlationid

Instructions to sales

Instructions to marketing ops

Package Insert

File size is currently limited to 800KB.

Package Label

File size is currently limited to 800KB.

FDA Approval Letter

File size is currently limited to 800KB.

Product Image or Product Example

File size is currently limited to 800KB.

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