apply.pepstakk.com

Apply to PepStakk’s Resupply Stack and Clinician Network.

One application. Pick the role or roles that fit how you operate, and we’ll route the rest of the form to match. Reviewing Clinicians, Channel Partners, and Suppliers (Source · Compounding · Distribution) all start here.

IN BUILD — Phase 4 of v1
§ 01 · Company / individual information
Tell us who’s applying.

Primary contact

Headquarters

§ 02 · Role multi-select
What roles are you applying for?

Pick one or more. You can hold Channel Partner and Reviewing Clinician roles together — a single entity record with two listings, separately vetted. Source / Compounding / Distribution are mutually exclusive supply-side tiers; pick one.

Group A — pick any (multi-select)
Group B — pick one supply-side tier (optional, mutually exclusive)
Sections that will render based on your selection
Pick at least one role to continue.
§ 03 · Tier sub-type
Pick your sub-type within the tier.
§ 04 · Minimum disclosure attestation
Sign the minimum-disclosure attestation.
PROVISIONAL · pending counsel review Date-stamped + IP-logged on submit

By checking the box below, I attest that the information I will provide in this application is accurate and complete to the best of my knowledge; I have authority to apply on behalf of the entity named above; I understand that PepStakk’s vetting and verification work is performed against PepStakk’s published frameworks and is not a regulatory designation; and I understand that material misrepresentation in this application is grounds for delisting and may be grounds for permanent exclusion.

§ 05 · Regulatory & licensing
Regulatory + licensing fields.
Source — base
Compounding — base regulatory
Does the facility handle controlled substances? required
503B — regulatory
503A — regulatory
Additional state licenses optional

Pharmacist-In-Charge (PIC)

Brand Owner — regulatory
Distribution — base regulatory
State wholesale licenses required · 1+ rows · each row PDF
Channel — medical director license
§ 06 · Compliance history
Disclose any prior recalls, regulatory action, or pending litigation.
Has the entity been subject to a recall in the last 5 years? required
Recall history
Has the entity been subject to FDA Warning Letters, state board action, or similar regulatory action? required
Regulatory action history
Is there any pending legal action material to operations? required
§ 07 · Operations & transparency
Operations & transparency fields.
Source — base operations
Active products required · 1+ rows

Testing matrix

Declare which tests are performed, skipped, or partial for each analyte. If any test is not "Skips", you'll need to name a third-party lab and upload COAs.

Last batch test dates required · per active product
Research Peptide Vendor — add-ons
Raw Material / API — add-ons
Reference Standards — add-ons
PROVISIONAL · pending counsel review Research-use-only attestation

I attest that the products listed above are sold for research use only and are not represented or labeled for human consumption. I understand PepStakk lists Source-tier vendors with a persistent “Research use only — not for human consumption” disclaimer.

PROVISIONAL · pending counsel review No human-use marketing attestation

I attest that no human-use claims, dosage suggestions, or therapeutic-use marketing for the listed products appear on our website, social media, or sub-brand surfaces.

Compounding — base operations

Standard operating procedures (PDF, ≤10 MB each)

Active peptide products required · 1+ rows
503B — operations
503A — operations
State board disciplinary history optional · if any
PROVISIONAL · pending counsel review Rx validation attestation

I attest that the pharmacy validates each prescription per the applicable state board of pharmacy rules; that compounded peptide preparations are dispensed pursuant to a valid prescription for an identified patient; and that the pharmacy maintains the required Rx recordkeeping per state law.

Brand Owner — operations
Manufacturing partners required · 1+ rows
FDA correspondence history optional · last 5 years
PROVISIONAL · pending counsel review · conditional on white-label partner White-label disclosure attestation

If any manufacturing partner is white-labeled, I attest that the brand owner has performed reasonable diligence on the underlying manufacturer's quality system and acknowledges responsibility for the finished product as labeled.

Distribution — base operations
Cold chain handled? required
State board correspondence optional · if any
Wholesale Distributor — add-ons
Warehouse locations required · 1+ rows
Drop-shipper — add-ons
Branded packaging — does the drop-shipper repackage / re-label? required
Fulfillment Partner — add-ons
Brand partners required · 1+ rows
PROVISIONAL · pending counsel review Distribution compliance attestation

I attest that the entity holds active state wholesale distributor licenses for all states in which it operates, and that the entity will notify PepStakk of any license suspension, surrender, or sanction within 30 days of occurrence.

§ 08 · Source declaration (upstream)
Name your upstream source(s).

Refusal to disclose the upstream source is a hard disqualifier, even if the source is itself a Vetted Compounding supplier. Cross-link logic uses this to surface "source-link" indicators on Distribution + Channel listings when the upstream is in PepStakk's Vetted Compounding directory.

Distribution — upstream sources
Upstream sources required · 1+ rows · refusal = hard disqualifier
Channel — source declaration
§ 09 · Channel practice disclosure
Channel practice — base + sub-type add-ons.
Channel — base (all sub-types)
Other prescribers optional · in addition to medical director
Practice locations required · 1+ rows

Testing matrix (peptides dispensed)

PROVISIONAL · pending counsel review Off-label marketing attestation

I attest that the practice does not market peptides as "curing," "treating," or being "FDA-approved for" any specific condition where they are not, and does not promote peptides for any indication outside the practice's scope.

PROVISIONAL · pending counsel review Scope-of-practice attestation

I attest that the services described above are provided within the scope of the medical director's license and applicable state law, and that any non-physician staff operate within their respective licensed scopes under appropriate supervision.

Wellness Center — add-ons
Aesthetic Medicine — add-ons
Special license types optional · e.g. RN scope, esthetician license
Telehealth Provider — add-ons
Prescribers by state required · 1+ row per state in "States licensed"
Independent Prescriber — add-ons
Additional state licenses optional · beyond medical director state in §05
§ 10 · Reviewing Clinician vetting (8-step)
Eight steps. All required. Binary outcome.

Per the PepStakk Clinician Network framework. Sample-work review (Step 5) is the load-bearing step — it’s what distinguishes a clinician who actually operates in peptide protocols.

Step 01 · License verification
Additional state licenses optional
Step 02 · Identity + credential check
Step 03 · Federal exclusion-list scan
System-populated post-submission. PepStakk runs OIG LEIE, state Medicaid exclusion lists, and DEA registration checks against the credential information you provided in Steps 01–02. No fields to complete here.
Step 04 · Peptide-experience attestation
PROVISIONAL · pending counsel review Date-stamped + IP-logged on submit

I attest that the peptide-experience information I have provided is accurate and complete to the best of my knowledge. I understand that material misrepresentation here is grounds for permanent exclusion from the PepStakk Clinician Network.

Step 05 · Sample work review

PepStakk needs to see how you actually approach a peptide-protocol review. Choose one method.

Sample work method required
Step 06 · Peer reference

Name one peer in (or eligible for) the PepStakk Clinician Network. PepStakk will follow up with them directly.

Step 07 · CE / publication evidence
Step 08 · Informational-review + COI attestation
PROVISIONAL · pending counsel review Informational-review attestation · date-stamped + IP-logged

I attest that any review I provide through PepStakk is informational, written, and asynchronous; that my review does not establish a clinical relationship between me and the Stakker; that I am not the Stakker’s prescriber by virtue of providing a review; and that PepStakk does not certify any individual review of mine as medical advice.

PROVISIONAL · pending counsel review COI disclosure attestation · date-stamped + IP-logged

I attest that the COI disclosure I provided above is complete and accurate to the best of my knowledge.

§ 11 · Certification interest
Optional — opt in to the Compounding certification track.

Certification is independent of Vetted Supplier status. Disclosure tier (Comprehensive / Standard / Limited) reflects what you disclosed; certification reflects what PepStakk independently verified. You can be Vetted without being Certified.

Interested in pursuing PepStakk certification on top of Vetted status? required
§ 12 · Review & submit
Review what you entered, then submit.
PROVISIONAL · pending counsel review Truth attestation · date-stamped + IP-logged on submit

I attest that all information I have entered in this application is accurate and complete to the best of my knowledge. I understand that material misrepresentation is grounds for delisting and may be grounds for permanent exclusion. I understand that PepStakk reserves the right to suspend or remove any listing that fails ongoing disclosure or verification requirements.

Per-file uploads cap at 4 MB (Airtable free-tier limit). If a file exceeds 4 MB, compress at smallpdf.com or similar before re-uploading.

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Application received.

Thanks. We review every application and will respond within a week. Your confirmation reference is — keep it for your records.