Service and Supply Request - BC - Health Products Stewardship Association

A service provider will be notified to perform the supply and pick up at your location within 10 business days.
Minimum pick up of two (2) items is required to schedule a service.
Containers 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.

* Required information

Pharmacy Information
Pharmacy Name*
HPSA ID*
Address*
Make sure the information below matches the pharmacy's shipping information.

Street Address City Province Postal Code
Requester's Information
Requester's Name*
Requester's Title*
Pharmacist Licence #*
Phone Number*
Email*
Program Check-list
Please confirm the following. Should you have any doubt or answer NO to any of the questions below, please contact the HPSA Team at info@healthsteward.ca
1.) I confirm that only consumer returns of medications have been placed in the medication return containers.*
- Yes
- No
2.) I confirm that there are no free liquid in the medication return container(s).*
- Yes
- No
3.) I confirm that the lid on the medications return container has been securely sealed.*
- Yes
- No
New Supply Order
Indicate the number of items to be delivered.
Medications Return Container*
Pick-up Request
Indicate the number of items to be picked up. A minimum of two (2) items is required to schedule a pickup.
Medications Return Container*
Please enter a number greater than or equal to 2.
Comments or questions
Please provide us any additional requests, comments or questions.
Additional requests, comments or questions
HPSA STAFF ONLY SECTION
HPSA use only (do not fill out)
Region/county: Service Provider: Date Sent: Received By:
Name
This field is for validation purposes and should be left unchanged.

Service and Supply Request – BC