Descriptions of Available Forms
It is important to use your correct DEA number and the name used for DEA registration. Please include your
wholesaler account number and address on all request forms to ensure proper credits.
Safe-D Pak Forms - are used to order a Safe-D
Pak to dispose of unwanted controlled substances.
Schedule 2 Request Form - is used to identify your Schedule 2 items before shipping. We will
capture the appropriate data to ensure that a correct DEA Form 222 is issued. Please note that DEA regulations
prohibit the transfer of a Schedule 2 item without prior issuance of DEA Form 222.
Schedule 3-5 Request Form - is used to identify the Schedule 3-5 merchandise in your return
for accountability during shipment.
Pharmaceutical Inventory Form - is used to record unscheduled merchandise being shipped to
The Rx Exchange.
Federal Forms
During the returns process there may be one or more forms required to be completed for the DEA. We will
complete and send you the necessary forms for your return after you send us the relevant Request Form shown above.
The Federal forms are described below:
- DEA Form 41 - a federal form used to record the
destruction of controlled substances.
- DEA Form 106 - a federal form used to report the
theft or loss of controlled substances.
- DEA Form 222 - a federal form to record the transfer
of a CI or CII substance from one registrant to another.
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