QuickMAR Pharmacy Partner Application & Master Agreement

Partner Application

Only upon written notification by QuickMAR of application approval, pharmacy will be authorized to begin licensing, interfacing with and promoting QuickMAR (including electronic medication administration record – eMAR) to be interfaced (electronically or manually) with the pharmacy indicated above and facilities served by the pharmacy in accordance with these terms & conditions.

Each pharmacy location must pay QuickMAR a $2,000 one-time start-up fee.
QuickMAR will license “QuickMAR Rx”, with accompanying interface and management tools to the pharmacy, and “QuickMAR” to the facility under a separate end user license agreement.
Since Pharmacy owns the primary relationship with Facility, QuickMAR will provide a consolidated invoice to Pharmacy for BOTH the software licensed to Pharmacy and software separately licensed to the Facility. Pharmacy will invoice indicated amount to Facility.
Pharmacy’s portion for software licensed to and installed at the pharmacy is reflected in the monthly fee per Active Resident.
Pharmacy will invoice the monthly fee per Active Resident for the software licensed to and installed at the Facility.
As a partner pharmacy, all billing will be sent directly to the pharmacy. QuickMAR can itemize your billing to help you understand the breakdown of costs for convenience.
Facility may opt to purchase other QuickMAR products or services directly from QuickMAR or that pharmacy may choose to be invoiced by QuickMAR through pharmacy.
Transfer fees are not applicable for facilities changing to QuickMAR from paper MARs or competing eMAR systems. However, if a Facility is already using QuickMAR and interfaced with another Pharmacy, a mandatory fee of $975/facility is required to transfer it to your pharmacy.
QuickMAR collaborates with a wide range of industry partners, which may provide additional pricing incentives beyond those shown above:

Please Check All That Apply: (applicable pricing adjustments will be applied)

Your Pharmacy Software*

Pharmacy to be Invoiced

Pharmacy Name*

Address*

Street Address City State / Province / Region ZIP / Postal Code

QuickMAR Pharmacy Contact E-mail*

Accounting Contact E-mail*

Sales Contact E-mail*

IT Contact E-mail*

Requested QuickMAR Start Date: (Must be at least 4 weeks from this date)*

Pharmacy Authorized Contact Name*

Pharmacy Authorized Contact Title*

Pharmacy E-mail*

Pharmacy Phone*

*

I certify that I am an authorized officer or other duly authorized agent of the company, authorized to execute this legally binding agreement.

Terms & Conditions

Please review all terms and conditions.

*

I have reviewed and agree to all terms and conditions.

Startup Fee

Pay your startup fee to continue the signup process. All Fees will be due within 30 days following the month in which the Fee was incurred, or if invoiced by MMT, within 30 days of the date of MMT’s invoice therefore. Any Fee or other amount that is not paid when due will accrue interest at 18% per year (1.5% per month) or the maximum rate permitted by applicable law, whichever is less, from the due date until paid. All payments must be made in U.S. dollars.

Pay Now (Optional)

Pharmacy Prep Sheet

Please fill out the form below, to provide QuickMAR's team with the necessary information to start scheduling implementation steps with you and your facility.

Company Name*

Dispensing Software*

Years using dispensing software*

Facility beds currently servicing*

Training Location Address

Address*

Street Address City State ZIP Code

Contact handling training logistics

Name*

Phone*

Email*

IT Contact

Same as above?

Yes
No

Name*

Phone*

Email*

Pharmacy contact implementing QuickMAR interface to dispensing software

Same as above?

Yes
No

Name*

Phone*

Email*

Notes

Facility Prep Sheet

Please fill our the form below, to provide QuickMAR's team with the necessary information to start scheduling implementation steps with you and your facility.

This facility is:*

New to QuickMAR
Already Using QuickMAR

Facility Name*

City*

State*

Prior Pharmacy Name*

When an existing QuickMAR facility changes from one QuickMAR pharmacy partner to a different QuickMAR pharmacy partner, QuickMAR charges the receiving pharmacy a standard $975 transfer fee per facility.

To ease the transition from one pharmacy to the next, QuickMAR offers certain services to preserve information the facility has entered and owns. Proprietary pharmacy information (such as orders entered by the pharmacy and imported into QuickMAR) will NOT be transferred from one pharmacy's QuickMAR database to the next, but most of the facility's internally-configured settings can be transferred. Please indicate which information you would like to preserve.

Company Name*

Facility Type:*

Number of Beds*

Please enter a number greater than or equal to 1.

Facility Address

Address*

Street Address City State ZIP Code

Number of staff to train*

Number of med and treatment carts*

Contact handling training logistics

Name*

Phone*

Email*

IT Contact

Same as above?

Yes
No

Name*

Phone*

Email*

Notes

Sales Level	Active Residents	Monthly Fee /Resident
1	1-499	$9.00
2	500-1499	$8.00
3	1500-2999	$7.00
4	3000-4999	$6.00
5	5000	$5.00

Partner Application

Please Check All That Apply: (applicable pricing adjustments will be applied)

Pharmacy to be Invoiced

Terms & Conditions

Startup Fee

Pharmacy Prep Sheet

Training Location Address

Contact handling training logistics

IT Contact

Pharmacy contact implementing QuickMAR interface to dispensing software

Facility Prep Sheet

Facility Address

Contact handling training logistics

IT Contact

I am a QuickMAR Pharmacy Partner.

I was referred by a pharmacy.