Service and Supply Request - MB

A service provider will be notified to perform the supply and pickup at your location within 10 business days.
Minimum pick up (2) and delivery of two (2) items is required to schedule a service.
Containers and boxes must be full before requesting a pickup (no more than 23 kg per MRP container and 12 sharps container per box).
Please keep a copy of the automated email receipt and the associated courier receipt on file at your pharmacy.

* Required information

Pharmacy Information
Pharmacy Name*
HPSA ID*
Address*
Make sure the information below matches the pharmacy's shipping information.

Street Address City Province Postal Code
Requester's Information
Requester's Name*
Requester's Title*
Pharmacist Licence #*
Phone Number*
Email*
Attestation*
- I attest that no vaccination syringes are included in the sharps containers.
Program Check-list
Please confirm the following. Should you have any doubt or answer NO to any of the questions below, please contact the HPSA Team at info@healthsteward.ca
1.) I confirm that only consumer returns of medications have been placed in the medication return containers.*
- Yes
- No
2.) I confirm that there are no free liquid in the medication return container(s).*
- Yes
- No
3.) I confirm that the lid on the medications return container has been securely sealed.*
- Yes
- No
4.) I confirm that the plastic liner within the Sharp Over-Packaging been tied off and the box sealed with tape.*
- Yes
- No
New Supply Order
Indicate the number to be ordered. A minimum delivery of two (2) items is required to schedule a service.
Sharp Case*
Includes 75 sharp containers
Sharp Over-Packaging*
1 flat return box
Liners for Over-Packaging*
1 liner per flat return box
Medications Return Container*
Includes: 1 container, 1 lid, 1 liner & zipties
Total Number of Items (Calculated Field)
Minimum 2 items is required. When this calculated field is correct, you will see submit button.
Pick-up Request
Indicate the number to be ordered. A minimum pick-up of two (2) items is required to schedule a service.
Medications Return Container
Please enter a number greater than or equal to 0.
Sharp Return Box
Approx. 12 sharp containers per box
Total Number of Pick-up Items (Calculated Field)
Minimum 2 items is required. When this calculated field is correct, you will see submit button.
Comments or questions
Please provide us any additional requests, comments or questions.
Additional requests, comments or questions
Name
This field is for validation purposes and should be left unchanged.

Service and Supply Request – MB

Pharmacy Information

Requester's Information

Program Check-list

New Supply Order

Pick-up Request

Comments or questions

Our Offices

Find your HPSA ID number on the Drop-Off Location Map by submitting your pharmacy postal code