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 Pharmacy Valuations:
