Questions to Ask Your Pharmacist
Drug Monitoring Program

Prescriptive Authorities for Pharmacists
ONE Opioid and Naloxone Education
Drug Repository Program
Retail Meth Watch
Immunization Resources

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