Add Location - Rx Drug Drop Box

Add New Locations
Number of Locations*
Location Spreadsheet
Please download the following spreadsheet template. Once filled out, return to this form to submit it.

Download Sample Spreadsheet
Spreadsheet Upload*
Accepted file types: csv, xls, xlsx, Max. file size: 5 MB.
Contact Info
Contact Name*
First Last
Contact Organization*
Contact Email*
Contact Phone*
Drop Box Info
Location Name*
Location Address*
Street Address Address Line 2 City State ZIP Code
Specific Location of Drop Box*

1st floor, Lobby, etc
Hours of Operation (Open to the Public)*

ex. Mon-Fri 9a-6p or 24/7
Location Phone
Location Website
Location Notes / Additional Details
Location Photos
Location Photos
Drop files here or

Accepted file types: jpg, jpeg, png, tiff, Max. file size: 5 MB, Max. files: 5.
Name
This field is for validation purposes and should be left unchanged.

Do you manage one or more locations that have prescription disposal boxes?

Please fill out the following form so we can add your locations to our locator.

Your local community will be thankful that you submitted this location info!

Keeping our listing data current and correct is essential to providing a great service. We verify submissions before applying them so valid contact info is required.

Add New Locations

Location Spreadsheet

Contact Info

Drop Box Info

Location Photos

Locations

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