Additional Information Require

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1 Sales Rep: Credit Application Principles/Officers Contact Information Name: Tel. Name: Tel. Company Information Name: Billing Address: City: ST: Zip: Ship to: City: ST Zip Phone: Type of Business : Fax: (Retail, LTC, Hospital, Specialty) References Bank: Account: City: ST: Zip: Tel: Bus. Ref. (1): Bus. Ref. (2): Tel.: Tel.: Compliance (All Application must submit copy(ies) of licenses listed below.) DEA License: ST: Exp. Date: / / State License: ST: Exp. Date: / / Agent/Rep Contact Information Purchasing: A/P: Compliace: Invoices: Additional Information Require Have there been any disciplinary actions taken by state/federal agencies against the company as well as any of its principles, owners, or officers over the last ten years, or since the company was first licensed, or since any of the listed individuals were first in the prescription drug wholesale business? Please list all if any attach if necessary.

2 Has the company ever had any disciplinary actions by local, state, or federal authority with regards to pharmaceutical storage, handling, and distribution?. If yes, please provide detail information: attach if necessary. Have any of the owners and/or officers ever been convicted of a felony? If yes, please list in detail the offense, location, sentence, and current position. I/We hereby attest, that all information contained herein is complete and accurate. This information has been furnished with the understanding that it is to be used to determine the terms and conditions of the line of credit to be extended. Furthermore, I/We hereby authorize the financial institution(s) listed in this credit application to release informa-tion to MedMax Rx, Inc. Agreement: Terms are NET 10 EOM (subject to credit approval) All Invoices are to be paid in full (If not paid on time, a 1.5% monthly finance charge will be added.) Any claims arising in regards to merchandise received must be made within three business days of re ceipt of shipment. If failure to make payment, you agree to reimburse MedMax Rx, Inc. any and all cost related to collection costs and services. Accept the terms as stated in shipping Policy. I/We certify that am/are authorized to sign on behalf of the applicant, and agree to the conditions and terms. Signature Principal/Guarantor(s) Signature: Name: Title: Date: / /20 Signature: Name: Title: Date: / /20 For your convenience, you could Scan/ or Fax Application with supporting documentation to: NEWAPP@MEDMAXRX.COM or Fax:

3 Shipping Policy Shipment processing time and schedule: In most cases all orders received prior to 6:00PM EST*, Monday through Friday, will be processed and shipped the same day. Orders placed after 6:PM EST* cutoff times will be shipped the following business day. Orders place on holidays or weekends will be process the next normal business day. All refrigerated products ship overnight. Refrigerated Orders received Friday will be process and Ship the following Business day. MedMax Rx reserves the right to change or modify this policy at any time and may make exceptions as deemed necessary. * Excluding orders held for Credit or Compliance Review. Return Policy To be eligible for a RMA (Return Merchandise Authorization) you must submit a request for RMA within five business days from invoice date. You also attest that the returning product(s), were purchased directly from MedMax Rx, Inc. and that the product(s) have been stored properly at the temperature indicated on the product label, in its original undisturbed packaging. Product(s) packaging and sealed has not been tampered,opened, or repackaged in any form, according to the Prescription Drug Marketing Act. Upon RMA approval a 20% or $20.00 (whichever is greater) re-stocking fee will be accrued. Return Authorization form must match* and accompany the returned product(s). Credit(s) will be issued, based on the current selling price or original invoice price, whichever is lower, and any adjusted terms/conditions such as: discounts, r ebates, free goods, etc. if applicable. Credit will be issued within 30 days of receipt. No deductions may be taken prior to that time. All credits will be issued in the form of a credit memo, no checks will be mailed. Sales representatives cannot authorize return of products or pick up merchandise. All returns must be authorized by MedMax Rx, Inc. Account Receivables department. *Any and all unauthorized returned product(s), unapproved quantities, lot numbers, or expiration dates, will be shipped back at your expense, including a $35.00 processing fee. NO CREDIT will be given for the following: 1. Any product(s) that are short-dated or close-out inventory. 2. Refrigerated products. 3. Opened or partial bottles; Repackaged products or products not in original sealed container. 4. Product defaced with stickers, price marks, knife cuts, etc. 5. Damaged merchandise by any form, means, or otherwise in violation with any Federal, State or local law or regulation. 6. Free goods. 7. Any product purchased 30 days from day of invoiced. HOW TO REQUEST AUTHORIZATION FOR RETURN Contact our Account Receivables Department at T:(844) ; F:(516) ; or RMA.Request@medmaxrx.com to request a return authorization form for any product(s) you wish to return for credit. To ensure proper processing, you must supply all pertinent product(s) information, invoice number(s), specific lot number(s) and expiration date(s). ORDER ERRORS Shipping errors must be reported within 48 hours of receipt and are returnable for full value at our expense. MedMax Rx will provide a preferred carrier call tag for returns due to our error. Please note these tags are only valid for 5 days and may only be used for product(s) shipped* in error. *RMAs or unauthorized product(s) added to shipment will be refused at your expense. 90 Alpha Plaza Hicksville, NY Toll Free: (844) Tel: (516) Fax: (516) newapp@medmaxrx.com

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5 1600 McConnor Parkway Schaumburg, IL JESSICA ASKARI MEDMAX RX INC. 115 COOPER DRIVE GREAT NECK, NY June 12, 2017 RE: 2017 Wholesale Distributorr Accreditation Requirement Extension JESSICA ASKARI, OptumRx is providing an updated version for extensionn to our requirements related to sourcing of medications fromm accredited wholesale distributors. The information you previously provided satisfied our expectations to grant a CONTINUED TEMPORARY EXTENSION to the requirement through June 30, 2017 and will expire on December 31, Additional extensions after the December 31 date will be managed by OptumRx on a one off basis and additional information will be provided to those wholesalers still awaiting VAWDD accreditation. With the grantingg of this extension, the wholesaler agrees that OptumRx may inquire to the status of the VAWDD accreditation with NABP for the sole purpose of gaging the status of completion for the VAWD accreditation. Any change inn that status that would indicate your organization will not achieve VAWD accreditation should be immediately communicated to OptumRx. This is a continued interim extension and is only for the period of time indicated above. OptumRx maintains that our contracted Network Pharmacy Providers must source medications from an accredited source. This interim extension may be revoked at any time at the sole discretion of OptumRx. If theree are any questions or concerns please contact thee credentialing department at credentialing.contracting@optum.com. Sincerely, LK Credentialing Department OptumRx