Prescription Drop Off/Activation Form

OMB 0720-0074

Latest Forms, Documents, and Supporting Material

Document Name
Form DHA Form 298 DHA Form 298 Prescription Drop Off/Activation Form Form
0720-PDOA_SSA_2.13.2024.docx Supporting Statement A
TAB A_Draft_DHA_AI XXXX.xx MTF Authorized Pharmacy Forms Guidance (03.23.23).docx Supplementary Document
DHA Form 298 Prescription Drop Off/Activation Form Form