• A courier vehicle will be dispatched to perform the supply and pickup at your location within 10 business days.
  • A minimum delivery of two (2) items is required to schedule a service.
  • Containers and boxes must be full before requesting a pickup (no more than 23 kg per container).
  • Please keep a copy of the automated email receipt and the associated courier receipt on file at your pharmacy.
  • Pharmacy Information

  • Make sure the information below matches the pharmacy's shipping information.
  • Requester's Information

  • Program Criteria

  • New Supply Order

    Indicate the number of items to be delivered.
  • Pick-up Request

    Indicate the number of items to be picked-up. A minimum of two (2) items is required to schedule a pickup.
  • Please enter a number greater than or equal to 2.
  • Comments or questions

    Please provide us any additional requests, comments or questions.
  • HPSA STAFF ONLY SECTION

  • This field is for validation purposes and should be left unchanged.