Order Provocholine® Solution

Provocholine Solution can be purchased through the wholesalers below. If you are having difficulty ordering through the wholesalers, please contact Methapharm Customer Service at 1-833-887-7686.

Provocholine Solution is also available for purchase directly through Methapharm. Products can purchased through our new online portal. Creating an account is quick and easy. For questions or support, contact our Customer Service team at ussales@methapharm.com or 1-833-887-7686.

Alternatively, products can be purchased by completing and submitting an Order Form.

This field is hidden when viewing the form

Next Steps: Sync an Email Add-On

To get the most out of your form, we suggest that you sync this form with an email add-on. To learn more about your email add-on options, visit the following page: (https://www.gravityforms.com/the-8-best-email-plugins-for-wordpress-in-2020). Important: Delete this tip before you publish the form.

Institution Name(Required)

Customer/Account Number(Required)

Customer P.O. Number(Required)

Your Name(Required)

Your Title(Required)

Email(Required)

Phone(Required)

Special Terms / Conditions

Comments

This field is for validation purposes and should be left unchanged.

Product Ordering Information

Products

	NDC	UPC Code	Pack Size
Provocholine Inhalation Solution (Now Available)	64281-110-06	364281-11006-4	6 kits / carton

	NDC	UPC Code	Pack Size
Provocholine Inhalation Solution (Now Available)	64281-110-06	364281-11006-4	6 kits / carton

US Wholesaler Ordering Codes

	AmerisourceBergen	Cardinal Health	Henry Schein	McKesson	Morris & Dickson
Provocholine Inhalation Solution (Now Available)	10273560	5807961	142-7692	2645786	168898

	AmerisourceBergen	Cardinal Health	Henry Schein	McKesson	Morris & Dickson
Provocholine Inhalation Solution (Now Available)	10273560	5807961	142-7692	2645786	168898