Enter the manufacturer's information and your user profile if you will be responsible for submitting drug pricing information to the California Department of Health Care Access and Information. Please input the information below and then click the Submit button.

    Items marked with an asterisk * are required.

Manufacturer Information
* Manufacturer Name: 
* Street Line 1: 
Street Line 2: 
* City: 
State/Province/Region: 
* ZIP/Postal Code: 
* Country: 
HCAI ID: 


Your User Profile
* User Email: 
* First Name: 
Middle Initial/Name: 
* Last Name: 
Title: 
Organization: 
* Street Line 1: 
Street Line 2: 
* City: 
State/Province/Region: 
* ZIP/Postal Code: 
* Country: 
* Phone/Extension:   
Fax: 
 
Check here if you are your manufacturer’s primary
contact for HCAI drug pricing reports
 

  
 

The Department of Health Care Access and Informations' Privacy Notice on Collection covers our practices regarding personal information collected when completing applications and forms (online and hardcopy) for our various programs, including the data collected for CTRx manufacturer and user registration.