Pharmacy Provider: Change Of Banking Details Of Pharmacy Only

Change Of Banking Details Of Pharmacy Only

Download the Request for Change of Banking Details form
Complete the required fields
Upload the completed Request for Change of Banking Details form
Upload the bank letter/statement reflecting the pharmacy banking details (not older than 3 months)
Upload a copy of the ID of the owner

For all queries related to new pharmacies and change of details please contact +27 (0) 860-932-273 or e-mail [email protected].

Change Of Banking Details Of Pharmacy Only

"*" indicates required fields

BHF nr*

Pharmacy Name*

Name & Surname*

Phone Number*

Email Address*

Application Form*

Upload completed application form

Max. file size: 128 MB.

Bank letter/statement reflecting the pharmacy banking details (not older than 3 months)*

Max. file size: 128 MB.

ID Document*

Max. file size: 128 MB.

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