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Service Request

As a participant in the WDSrx Returns program each facility will have their pharmaceutical drug products evaluated for Return Credit or Regulatory Compliant Product Disposition. WDSrx will provide each facility an inventory log detailing all items received along with credit summary sheets to track pending credits and certificates of destruction for their records.

Facility Information

Facility Name (required)

DBA

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Address Line 2

City (required)

State (required)

ZIP (required)

Phone (required)

Fax (required)

Contact Information

Primary Contact First Name (required)

Primary Contact Last Name (required)

Primary Contact Title (required)

Primary Contact Email (required)

License Information

DEA License Number (required - if not available put in XXX)

State License Number (required)

Wholesaler Information

Wholesaler Account Number (required)

Wholesaler Name (required)

Address Line 1 (required)

Address Line 2

City (required)

State (required)

ZIP (required)

Shipping Labels

Quantity of Shipping Labels (required, maximum 20)

Preferred Method of Receiving Labels (required)
FaxEmailMail

See our Packaging and Shipping Guidelines.

Are any Controlled Substances (CII) included in your return? If so, please press "Yes" and complete the DEA 222 Request Form. You can also contact Jason Solomon at jsolomon@wdsrx.com or (561) 998-3885 x316.