DisposeRx Packets:
Donation Application Form

DisposeRx is committed to the eradication of unused medications. As announced at the White House signing ceremony for the historic opioid legislation package known as HR-6, DisposeRx will be working with charitable organizations, faith—based groups and foundations to donate enough of our abuse—deterrent packets to destroy 10 million opioid tablets in home medicine cabinets across the nation.

If you represent a 501(c)3 organization, association, faith—based group or foundation and are interested in applying for a donation of DisposeRx packets, please complete and submit the following form. A DisposeRx representative will reach out to you in the near future.

Please include, based on the number of people you plan to reach, how many packets you are requesting, the project purpose and scope, and benefit to your community. Projects that will yield measurable program metrics and methods of quantifying success are preferred.

Note: The name of your organization may be used in DisposeRx marketing materials if you receive donated product.