BVEH...Leaders in Equine Medicine / Home Delivery

**Please note - your horse must be a current patient of BVEH for your prescription request to be approved**

Name On Card		Expiration Date
Card Number		Security Code	(What's this?)

Name/Address of Pharmacy:	Strategic Pharmaceutical Solutions, Inc. DBA VetSource Home Delivery, 17014 NE Sandy Blvd, Portland, OR 97230-0000
Name & Professional degree of PIC (all states except AZ):	Laura Hysen, RPH
States of Licensure of PIC:	AR, KY, LA, MI, OR, NE, TN, VA
PIC for Arizona:	Thomas West, RPH, MS
States of Licensure for T. West:	AZ, MI, OR
Name, address, telephone number, professional degree, and states of licensure of any practitioner who has a contractual relationship to provide medical evaluations or issue prescriptions for controlled substances, through referrals from the website or at the request of the owner or operator of the website, or any employee or agent thereof.	VetSource Home Delivery does not contract with any practitioner to provide medical evaluations or issue prescriptions for controlled substances, through referrals from the website or at the request of the owner or operator of the website, or any employee or agent thereof.

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