Supplies Request

To request supplies, please complete the form below with your needs. One form person, per day. Please provide an email or phone number for PCCSU to contact you regarding pick up/drop off. Below is a description of each item. Thank you.

Supplies Request Form

Narcan Nasal Spray (Box of 2): the opioid reversal drug Narcan Nasal Spray (Box of 2): the opioid reversal drug Narcan Nasal Spray

Qty

Cabinet Lock: locking device that can be placed on a cabinet or refrigerator to prevent unauthorized access to alcohol or medications Cabinet Lock: locking device that can be placed on a cabinet or refrigerator to prevent unauthorized access to alcohol or medications Cabinet Lock

Qty

Medication Locking Pouch or Box: a secure, portable container designed to safely and securely store medications, preventing unauthorized access Medication Locking Pouch or Box: a secure, portable container designed to safely and securely store medications, preventing unauthorized access Medication Locking Pouch or Box

Qty

Medication Disposal Bag: a device that allows for the safe and environmentally friendly disposal of unused or expired medications Medication Disposal Bag: a device that allows for the safe and environmentally friendly disposal of unused or expired medications Medication Locking Pouch or Box

Qty

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PCCSU

Awareness • Prevention • Community

Supplies Request

Supplies Request Form

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