Narcan Return 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*Local Health DepartmentCommunity Services BoardIndependent Health Department (Arlington or Fairfax)Comprehensive Harm Reduction ProgramLaw EnforcementFire Service (non-EMS licensed)Licensed EMSPublic SchoolSite Name* Contact Phone Number*Contact Email* Enter Email Confirm Email Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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*No issues with NARCAN®, but it will expire within 12 monthsNARCAN® is expiredOtherIf you selected other please explain:*
