Order Forms & Purchasing Information

Placing an order is quick and easy!

Helping You.

We are always happy to assist you or answer any questions.

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Rx Scan Technology - It's the smartest thing you can do to ensure prescription safety.

With the addition of hand scanners to the ADM, we now can stock virtually everything by barcode. It is a simple handheld solution for ‘unit of use/unit dose packaging” that utilizes barcode technology to improve dispensing safety from receipt to med station. 

Good Samartitan
Health Center

Step 1: Download our convenient, easy to fill out electronic order form.

Contact us at 800-572-2648 x 1 or sales@rxscan.com for NDC Translator purchasing information or volume pricing.

Download RxScan Ultra Order Form

Download Plus Prescription Verifier Order Form

Please Note: You will need the free Adobe Reader to view and download the order form.

Download Adobe Reader

Step 2: Billing and Shipping information

Fill out the Bill To information. Fill out the Ship To information.

Make sure you fill in your email address and telephone number, in case we have to contact you about your order.

Step 3: Order Information

Fill in the number of each item you wish to order and the form will automatically calculate the total cost for the total number of each item you wish to purchase.

Ohio residents please select 6.75% Sales Tax. The form will calculate the sales tax in the box next to the words "Sales Tax."

Enter the shipping charges in the box next to the words "Shipping."  Shipping is $15 for the first item and $5 for each additional item.

Step 4: Reviewing Your Order

Carefully check your order form to make sure the information is correct.

Then sign and date the order.

Step 5: Submit Order

Please submit all orders to:

Fax: (740) 548-1745 or email to sales@rxscan.com