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Listed below are forms
and instructions that will assist you in processing your returns through
Pharma Logisticsâ. You will need the free Adobe Acrobat Reader® to
view these forms. You can dowload Acrobat Reader here.
If you have any questions, please contact us at 888-729-7427.
DEA
41: Registrants Inventory of Drugs Surrendered
(131 KB / 2 pages)
NOTE: Your
pharmacy does not need to complete a DEA Form 41 if you are shipping
your products to Pharma Logistics for processing.
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PURPOSE: |
To document
the surrender of controlled substances which have been forwarded by
registrants to DEA for disposal. |
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ROUTINE
USES: |
This form is
required by Federal Regulations for the surrender of unwanted
Controlled Substances. Disclosures of information from this system
are made to the following categories of users for the purposes
stated. A. Other Federal law enforcement and regulatory agencies for
law enforcement and regulatory purposes. B. State and local law
enforcement and regulatory agencies for law enforcement and
regulatory purposes. |
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EFFECT: |
Failure to
document the surrender of unwanted Controlled Substances may result
in prosecution for violation of the Controlled Substances Act. |
DEA
106: Report of Theft or Loss of Controlled Substances
(235 KB / 2 pages)
NOTE: This form is
used to report the theft or loss of controlled substances from your
pharmacy. The DEA also suggests using this form to record breakage when
it occurs in your pharmacy. This form can be downloaded blank or
completed online and then printed.
Privacy
Act Information for DEA Form 106
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PURPOSE: |
Report theft
or loss of Controlled Substances. |
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ROUTINE
USES: |
The Controlled
Substances Act authorizes the production of special reports required
for statistical and analytical purposes. Disclosures of information
from this system are made to the following categories of users for
the purposes stated: A. Other Federal law enforcement and regulatory
agencies for law enforcement and regulatory purposes. B. State and
local law enforcement and regulatory agencies for law enforcement
and regulatory purposes. |
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EFFECT: |
Failure to
report theft or loss of controlled substances may result in
penalties under Section 402 and 403 of the Controlled Substances
Act. |
DA
Form 3161: Request for issue or turn-in
(48 KB / 1 page)
This form is used as a hand receipt
between an accountable officer and the person receiving the property and assuming
direct responsibility for it. This form can be downloaded blank or completed online and then printed.
Facility
Information Sheet (19 KB / 1 pages)
Print this form to
update or complete your pharmacies information including wholesaler
information, phone numbers, contact names, etc. You can also use the New
Customer Signup form in lieu of this form.
Manual Form
222 Request (27 KB / 1page)
This form is used to
inventory your Schedule 2 controlled substances.
You can print blank copies of this form and perform your inventory on the copy.
Schedule
III-V Inventory Form (104 KB / 1page)
This form is used to
inventory your Schedule III-V controlled substances. You can inventory
these products right from your computer on this form or print blank copies
of this form.
ARS
Tracking Sheet (50.3 KB / 1page)
Print this sheet out
and you will have a handy reference sheet that will allow you to keep
track of your return shipments to Pharma Logisticsâ. Just peel and stick
your A.R.S. tracking labels on this sheet.
Inventory
Form for Legend and OTC Products (39.2 KB / 1page)
This is an optional
form that allows your pharmacy to inventory all of your legend and OTC
products before shipment.
Procedures
For Returning Componded-Mixed IV Bags (87.6 KB / 1page)
Pharma Logisticsâ can
accept for return any controlled substances that have been compounded or
mixed at your pharmacy. The DEA has specific rules that must be followed
on these products and the instructions are provided here.
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