Narcan Return – Epidemiology

NARCAN® Return Request

Please use this form if you have expired or unused Narcan Kits that you would like to return to the Virginia Department of Health, Division of Pharmacy Services. For questions filling out this form, please contact pharmacyvisions@vdh.virginia.gov.

Type of Organization*
Site Name*
Contact Phone Number*
Contact Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State ZIP Code

NOTE: We cannot ship to P.O. Box addresses.
Number of NARCAN® Kits Returning:*
Please enter a number greater than or equal to 1.
Has NARCAN® Left the Storage Area?*
- Yes
- No
Reason for Return*
If you selected other please explain:*