Get Henry Schein Dea Associates Form

Filling out the Henry Schein Dea Associates Form online can seem daunting, but with clear instructions, you can complete it efficiently. This guide provides step-by-step directions to help ensure that your form is filled out correctly and submitted for processing.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Enter the 'To' field with the recipient, which is Henry Schein, Inc.
3. Input the street address as 5315 W. 74th Street, Indianapolis, IN, and the zip code as 46268.
4. Fill in the date on which you are completing the form.
5. Under 'Order Details,' ensure that all fields are completed. This includes specifying the number of packages, size of the package, and the name of the item. Remember to list either the brand or generic name, but not both.
6. Indicate the last line completed. Ensure that every line utilized for orders is noted and that no lines are skipped.
7. Include your signature, or that of your attorney or agent. If signed by someone else, attach a Power of Attorney form.
8. Verify that your name and address match your currently registered DEA address. No changes are allowed.
9. Prepare to send the correct copies of the form: Supplier's Copy 1 (brown) and DEA Copy 2 (green), along with the carbon in between, to Henry Schein, Inc.
10. Do not make any alterations or corrections to the form. If any changes are needed, submit a new form without these alterations.
11. Leave the National Drug Code blank until you receive your shipment. Fill in the NDC, number of packages received, and the date after receipt.
12. Review your completed form, then save your changes. You can download, print, or share the form as necessary.

Take the first step by completing your Henry Schein Dea Associates Form online today.