Get Dea 222 Form Sample Leave This Area Blank - Sca Pharmaceuticals

Filling out the DEA 222 form can be a crucial process for ordering controlled substances. This guide provides detailed, step-by-step instructions to help you complete the DEA 222 Form Sample efficiently and accurately online.

Follow the steps to fill out the DEA 222 form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the name of the supplier in the designated section, which should read SCA Pharmaceuticals.
3. Fill in the street address of the supplier: 8821 Knoedl Court.
4. Provide the city and state, which is Little Rock, AR 72205.
5. In the date field, write the current date using the mm/dd/yyyy format.
6. Indicate the number of packages you are ordering in the corresponding field.
7. Next, specify the size of the package, such as 50mL or 10x5mL, according to what you are ordering.
8. Fill in the name of the item being ordered, including its strength (e.g., 50mcg/mL).
9. Ensure that the last line corresponds to the line number of the last product ordered, which must be 10 or fewer.
10. Sign the form. The signature must be of the purchasing physician or designated agent; if someone else is signing, a copy of the power of attorney must be on file.
11. Make sure not to write anything in the shaded areas, such as the supplier's DEA registration number or packages shipped.
12. Once completed, mail the top two copies (Brown and Green) to SCA Pharmaceuticals, retaining the bottom copy for your records.
13. If you need to make corrections, void the form and start over, except that you may void a line item and re-enter on a blank line.

Complete your DEA 222 forms online accurately to avoid any processing delays.