Questions to Ask Your Pharmacist
Drug Monitoring Program

ONE Rx Opioid and Naloxone Education
Drug Repository Program
Retail Meth Watch

Items in bold are required.

Participant Registration

"Participant" means a practitioner....

Contact Details

License or Permit Number: License Type:

Facility Name:

Contact Person:

Telephone Number: (ex. 7015551212) Extension: Email Address:

Address Where Drugs Are to Be Shipped/Stored

Street Address:

City: State: Zip: (ex. 12345 or 12345-6789)

Before being dispensed...

Records of distribution and dispensing must include:
 a. Name and address of participant
 b. Drug or device name