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Get NM Needle and Syringe Order Form 2018-2024

* Phone #* Fax #* *All fields are required to process order # of Boxes Requested Vanish Point® 3ml Syringe with Needle 23 gauge x 1 inch #100/box 25 gauge x 5/8 inch #100/box Needles Only # of Boxes Requested 23 gauge 1 inch, (Safe Glide®) 50 per box* 23 gauge 1 inch, (Eclipse®) 100 per box* 25 gauge 5/8 inch, (Safe Glide®) 50 per box * Warehouse will fill request with on hand inventory E‐Kit Medications Quantity Ordered Diphenhydramine Inj. (vial) 50mg/1ml #1 Epinephrine Inj. (vi.

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