Avicenna Pharmaceutical is a wholesale medical distributor serving licensed healthcare facilities and authorized providers exclusively. We do not sell to consumers or individual patients.

To comply with applicable federal and state healthcare distribution regulations, all customer accounts must complete facility verification prior to approval. Access to regulated medical products is restricted and granted only after successful verification.

Regulatory Compliance & Distribution Standards

Facility verification is a critical component of Avicenna Pharmaceutical’s compliance program and supports adherence to:

• Federal and state healthcare distribution regulations

• Office of Inspector General (OIG) guidance

• Drug Enforcement Administration (DEA) requirements for regulated products

• State Boards of Pharmacy and other applicable licensing authorities

Pharmaceuticals, allergy extracts, and other regulated medical products are distributed exclusively to properly licensed and verified healthcare entities. Controlled substances and restricted products are never supplied to unverified or unauthorized buyers under any circumstances.

Healthcare Practitioner Authorization Form (HPAF)

The Healthcare Practitioner Authorization Form (HPAF) is used to confirm that medical products are supplied solely to licensed healthcare facilities and authorized practitioners in accordance with applicable laws and regulations.

Completion of the HPAF is required as part of the account onboarding and verification process.

How to Complete the HPAF

Facilities may complete the HPAF using either option below:

• Online Submission:
  Complete the HPAF through our secure online verification form.

• Offline Submission:
  Download the HPAF, complete it offline, and email the finalized form with all required documentation to:

cs@avicenna-pharma.us

[Download the HPAF Form]

Required Information

To complete facility verification, all required fields must be completed and supported by appropriate documentation, including:

• Legal facility name (as registered with licensing authorities)

• Facility address and primary business contact information

• Authorized healthcare practitioner name and professional title

• Active professional and/or facility license number

• Licensing state and license expiration date

• DEA registration number, if applicable

• Authorized signature of the practitioner or facility representative

Additional documentation may be requested based on product type, regulatory classification, or jurisdiction.

Submission Guidelines

To avoid processing delays, please ensure that:

• All submitted information matches official licensing and registration records

• Copies of licenses and supporting documents are clear and legible

• The completed HPAF and all required documentation are submitted through the online form or emailed to cs@avicenna-pharma.us

Certification & Attestation

By submitting the HPAF, you certify that all information provided is true, accurate, and complete, and that your facility is authorized to purchase regulated healthcare products in accordance with applicable federal, state, and local laws.

Review & Verification Process

All submissions are reviewed as part of Avicenna Pharmaceutical’s compliance and credentialing process. Approval is subject to verification of licensure, registration, and eligibility.

Access to regulated, restricted, or controlled products is granted only after successful verification and account approval.

Need Assistance?

If you have questions regarding facility verification or documentation requirements, please contact our compliance support team at cs@avicenna-pharma.us