Dr.SurgeonPGH said:

They are two different exemptions from the same federal requirements and they buy different things.

Vendor communication red flags for compounded supply:

• Won't provide COA before purchase — walk away
• Claims "100% pure" without analytical data — unrealistic
• No physical address or phone number — accountability matters
• Pushes you to buy more than you need — pressure tactics
• Won't answer questions about their compounding process — transparency is key
• Payment only via crypto or wire transfer — legitimate pharmacies accept cards

A legitimate compounding pharmacy operates like a healthcare business, not a gray market dealer.

Following on from jim_asheville — and this may be the naive question:

Why a shortage listing created a legal pathway at all, since a shortage is a supply fact rather than a permission?

BethLabQueen said:

Vendor communication red flags for compounded supply: Won't provide COA before purchase — walk away Claims "100% pure" without analytical data —…

Coming at BethLabQueen’s question from a different direction. The trade-off is reversibility against privacy and there is no option that gives you both. Card payments are reversible and disclose the most; crypto discloses least and is irreversible, which is precisely why pressure toward it is a warning sign when it comes from a seller rather than a buyer. Escrow only means anything where the escrow agent is independent of both parties, which is rarely the case in practice.

Worth separating that from paying for it, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

Ask again with the specifics and you will get a better answer than this one.

OP back with an update, since a thread like this is useless without one.

The bulks-list asymmetry was the piece I had missed entirely. It explains why one of my two pharmacies is still arguing it can supply and the other simply stopped.

Dr.RaviCardio said:

The trade-off is reversibility against privacy and there is no option that gives you both.

Dr.RaviCardio has the substance of this right. The condition it depends on is worth stating. Worth adding the genuine exception, because it is real and narrow: a change made for an identified patient where the prescriber determines it produces a significant clinical difference for that patient. A grid of fixed doses offered to everybody is not that, whatever the intake form says.