Prescription Drug Pedigree Form
Use this form anytime you sell medications to physician offices or other licensed healthcare entities and you need to comply with the Drug Supply Chain Security Act (DSCSA).
Many states also regulate wholesale distribution, and this form was intended to include information most commonly required by state law.
Usage Rights and Disclaimer
Each download allows for the copy and use of the form for one pharmacy permit.
NOTE: This form is intended as an aid only and Pharmacy Compliance Specialists, LLC, shall not be held liable for damages resulting from the use or misuse of this product.