Wholesale Data Upload Account Registration * Denotes required field Company Information Company Name* Phone* Street Address* Fax* City* Web URL State* --SELECT ONE-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvannia Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West virginia Wisconsin Wyoming Zip Code* DEA and License Information DEA Number This facility does not have a DEA number Ohio Drug Distributor License Number* An Ohio licensed drug distributor may report sales and suspicious orders on behalf of another licensed drug distributor owned and operated by that distributor. After registration, an Ohio drug distributor can add more relationships under the Manage Relationships section. Once entered, an Ohio drug distributor may submit sales and suspicious orders on behalf of the facilities listed using this account. Primary Contact Information Name* Email Address* Direct Phone* Secondary Contact Information Name Email Address Direct Phone Login Information Username* Password** Confirm Password Having trouble creating a strong password? Click here to generate one. Click here to see username and password requirements. *A valid username must meet the following criteria: Alphanumeric characters (ex. ABC123) No special characters or spaces (ex. @$%&) At least 9 (nine) characters in total length Maximum of 50 (fifty) characters **A valid password must meet the following criteria: At least one upper case character (ex. ABC) At least one lower case character (ex. abc) At least one numerical character (ex. 123) At least one special character (ex. !#$) At least 12 (twelve) characters in total length Security Enable Two Step Authentication Adds a second layer of security to your account so that when you attempt to log in, the system will provide you with an authentication code via email, which you will be prompted to enter. Processing Your Request...