Remember that the form will be returned if any of the items below are
incorrect, incomplete or altered in any way. Proper DEA 222 form
Instructions are included on the back of each form. These forms
are sent to our Distribution Center.
1.
Enter the name of the supplier as
“ASD”
2
. Enter the street address as
“345 International Blvd, Ste 400A”
3.
Enter the City, State and Zip as
“Brooks, KY 40109”
4.
Enter the date on which you completed the form. Remember that
222 forms are valid for only 60 days from the date entered. You
cannot pre-date forms.
5.
There are 10 lines upon which to enter products. Under “No. of
packages”, you need to enter the number of packages of the
product you are ordering. Under “Size of Package”, enter
number of units per package (i.e. number of amps per
carton, number of syringes per box, number of capsules
or tablets per bottle, or if a single unit, enter VIAL, 4OZ, etc.).
Under “Name of Item”, enter the item’s name and strength
(i.e. Demerol 50mg injectable, Percocet 5/325mg tablet, etc.).
DO NOT FILL IN THE SUPPLIERS DEA REGISTRATION No.,
NATIONAL DRUG CODE, PACKAGES SHIPPED OR DATE SHIPPED!
These are to be completed by our warehouse. Only add the
National Drug Code if you have been instructed to do so by
our associates. Please do not put any other markings
(including lines) after you have entered your last item!
6.
Enter the Last Line Completed. This is to be interpreted as
the last line number on the form that you have written on.
(i.e. if you ordered one item, but used two lines to write
it in, you would enter a “2” under Last Line Completed).
7.
Sign the form!
8.
Keep the blue copy and send the first two copies, with
carbon attached to:
ASD
345 International Blvd, Ste 400A
Brooks, KY 40109
Sending the form via
UPS, FedEx, Airborne,
etc. recommended for
tracking purposes and
order expedition.
Class II Narcotics
Ordering Instructions
Filling Out DEA Form 222
