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This form is only for Eye Care Professionals and Providers. Patients should call 812-944-6500 for more information.

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Physician Name

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Last

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Your Name (name of person completing the form if different than requesting Physician above)

First

Last

Phone

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Practice Name

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Address

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City

State

Zip Code

Please indicate the Ophthalmology products in which you have interest.

EasyCataract (Pred-Moxi-Brom 1%/0.5%/0.075%) Drops
EasyDilateTP (Tropicamide-Phenylephrine 1%/2.5%) Drops
Other (Specify in Comments)

Comments

Westmoreland Pharmacy operates in full compliance with Section 503A regarding compounded drugs as defined in the FD&C Act. Compounded medications are generally not reviewed by the FDA for safety or efficacy. Westmoreland does not compound copies of commercially available products. References available upon request.

Phone

812-944-6500
866-944-6505

Text

812-730-4034

Fax

812-944-6900

Address

1945 State Street
New Albany, IN 47150

Hours

Monday–Friday
9am–6pm EST
Saturday
9am-1pm EST

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866-944-6505

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Request a Sample Kit

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