Community Partnership Questionnaire

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.

Step 1 of 4

Contact Information

Please confirm your organization’s point of contact’s name, spelling and contact information. Note that none of the answers you provide will immediately approve or decline your request.
Please confirm your contact information.
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