Get Ut Class D Controlled Substance Database Questionnaire

Filling out the UT Class D Controlled Substance Database Questionnaire is an important step for pharmacists in charge of facilities dispensing controlled substances in Utah. This guide will provide clear, step-by-step instructions to help you complete this essential document accurately and efficiently.

Follow the steps to complete the questionnaire with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your editing interface.
2. Begin by entering your name as the pharmacist-in-charge (PIC) in the designated field. Ensure that you provide a valid email address for future correspondence.
3. Fill in the pharmacy name and the email associated with the pharmacy. Make sure this information is accurate as it will be used for official communications.
4. Provide the complete pharmacy address including street address, city, state, ZIP code, and any applicable apartment or unit numbers.
5. Input the pharmacy telephone and fax numbers. Contact information should be up-to-date to facilitate any required communication.
6. Identify the contact person who will set up the Controlled Substance Database Transmittal. Include their phone number and email address.
7. Indicate both the CSD transmittal software vendor and the POS software vendor if they differ. This is necessary for operational compatibility.
8. Enter your NCPDP/NABP number and NPI number, as these are required fields for the registration process.
9. Complete the DEA number field to ensure compliance with federal regulations concerning controlled substances.
10. Provide the anticipated date for beginning operations. This information is crucial for planning and compliance purposes.
11. For each of the four Yes/No questions, select the appropriate response regarding your role and knowledge of the regulations. Ensure clarity in your understanding.
12. Finally, sign and date the form where indicated to validate your submission and ensure its authenticity.
13. Once completed, save the changes made to the form. You will also have the option to download, print, or share the questionnaire as necessary.

Complete your UT Class D Controlled Substance Database Questionnaire online today and ensure compliance with Utah regulations.