Get Pharmacy Medication Donation Form. A Two Page Form That Should Be Submitted To A Participating

This guide provides clear and concise instructions on how to appropriately fill out the Pharmacy Medication Donation Form, which is essential for submitting donated prescription drugs to a participating pharmacy. Whether you are donating on your own behalf or as a representative, following these steps will ensure a smooth and successful donation process.

Follow the steps to complete the Pharmacy Medication Donation Form.

1. Click ‘Get Form’ button to obtain the Pharmacy Medication Donation Form and seamlessly access it in your preferred document editor.
2. Fill in the Donor or Representative Information section. Ensure that the name is printed legibly. Include the facility name if applicable, followed by the appropriate address and phone number.
3. Navigate to the Medication Information section. List each prescription drug being donated individually, providing the complete drug name. Include the lot number, expiration date, source, and the quantity remaining for each drug.
4. Provide the NDC number, drug strength, and dosage as indicated on the pharmacy or manufacturer’s label for each item listed.
5. In the Donor Certification section, select the appropriate box for the donor type, then sign and date the form. This confirms that the drugs were properly stored and have not been compromised.
6. The Receiving Pharmacist must review the form. They will sign and date the Medication Donation Form, indicating acceptance of the donation at the pharmacy.
7. Once all fields are completed, save any changes made to the form. You may then download, print, or share the form as needed to complete the donation process.

Submit your completed Pharmacy Medication Donation Form online to participate in making a positive difference.