Assure IV
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Assure IV Infusions Customer Onboarding
(503B Outsourcing Facility)
Thank you for your interest in partnering with Assure IV Infusions.
Assure IV Infusions is a fully automated, FDA 21 CFR 210 & 211 and cGMP-compliant 503B outsourcing facility specializing in high-quality sterile IV bag manufacturing. To establish an account, please complete and return the following documentation.
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SECTION 1: Facility Information

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Shipping Information

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Billing Information

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SECTION 2: Authorized Purchaser

SECTION 3: Financial Information

Accounts Payable Information

Bank Reference for Credit Application

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Trade/ Vendor References (Minimum 3 Required): Please provide at least three pharmaceutical or medical trade references with whom you maintain an active credit account.

Reference 1

Reference 2

Reference 3

Financial Information

SECTION 4: Required Documents

  • Copy of Facility License (required)
  • Completed W-9 (If You Would Like to Request Credit Terms for Future Orders)

SECTION 5: Healthcare Entity Attestation

By signing below, the customer certifies that:
  • The entity is a licensed healthcare facility authorized to purchase compounded sterile drug products per 503B FD&C Act.
  • Products purchased from Assure IV Infusions will not be resold to the general public.
  • Products are intended for physician office -use or institutional administration.
  • The entity is not a re-packer, re-labeler or marketing firm that sells or transfers compounded drug products to other entities.
  • The entity is not a wholesale distributor and separately registered with FDA.
  • The entity is not a mail order pharmacy.
  • The entity agrees to cooperate with customer complaints, adverse event reporting investigations, drug product recall notifications, and other regulatory requirements.
  • The patient records where drug product is administered will be maintained for One (1) year past product expiration date.
  • If requesting credit terms, the entity authorizes Assure Infusions, Inc to investigate its creditworthiness, including contacting the listed trade and bank references, and to obtain credit reports from commercial credit agencies.