BioCare DSCSA Onboarding – Beginadmin2023-04-27T13:39:00-07:00 Please complete the following information. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.LayoutBusiness Contact First Name *Business Contact Last Name *LayoutBusiness Contact Title *Business Contact Phone Number *Business Contact Email *LayoutTechnical Contact First Name *Technical Contact Last Name *LayoutTechnical Contact Title *Technical Contact Phone Number *Technical Contact Email *Location Name * Location Name GLN * GLN GS1 Company Prefix * GS1 Company Prefix Address * Address Address Line 1Address Line 2City--- Select State ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeType * Type --- Select Type ---Sold ToShip ToOtherOther SpecifiedThird Party Integrator (Track & Trace) *Please identify your L5 Service Provider (SP) from the entries below. If you would like to use a Portal to access your DSCSA EPCIS data from SAP ICH, please check the ‘SAP ICH Portal Customer’ Box. If your L5 SP is not listed below, please specify this under ‘Other’, identify the SP and fill out the technical contact and email address.AxwayFrequentzLSPediarfxcelSAP ICHSAP ICH Portal CustomerTraceLinkOtherOther Communication Method Technical Contact If “Other” is selected, provide technical contact and email address LayoutOther SP Technical Contact First Name *Other SP Technical Contact Last Name *Other Communication Method Technical Contact Email *Submit
