Coronavirus (COVID-19)
AmerisourceBergen and our global businesses are highly engaged during the ongoing spread of the novel COVID-19 "Coronavirus."
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Become a Customer

New customer application process

We collect five categories of information about your pharmacy during the application process:
  • DEA license or HIN certificate
  • State Board of Pharmacy license
  • General business and contact information
  • Payment and credit information
  • State Sales & Use Tax exemption ID# or certificate

Complete and submit the below form to start the application process.

Prefer to take it slower? Call 866.638.1464, select option 3, and talk to a sales representative.

Payment & Credit Applications

SmartSource offers three payment and credit options. Select the one that works best for your business. Print, sign, scan and email the completed form to We'll review the form and contact you shortly about your application details. If you'd like help with your application, call 866-638-1464 and select option 3.

Need help?

Need assistance with your application? Want to learn more about working with us? Please call 866-638-1464 and select option 3 or email for support. 
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We are proud members of these organizations:

We are VAWD accredited.