Packet Request

Thank you for your interest in prescription drug safety. Please use the form below request two (2) free DisposeRx in-home medication disposal packets. Packets are available to North Carolina residents only.

Packets are provided by Community Impact NC (CINC) funded by Substance Abuse and Mental Health Services Administration (SAMHSA) c/o NC DD/MH/SUS.

Customer Information

Name *

First

Last

Email *

Phone Number *

Delivery Address *

Address Line 1

Address Line 2

City

State

Zip Code

Special Delivery Instructions *

Confirmation *

My shipping address is in North Carolina.

Packet requests without a North Carolina shipping address will not be honored. After submitting the form, you will be redirected to the CINC website.

Click here for more information about Community Impact North Carolina (CINC).

If you would like to establish a similar program in your community, please reach out to DisposeRx today.

Additional packets are available at most pharmacies and can be purchased online through DisposeRxDirect.com.