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The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county & community efforts.

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Repository Forms

Division of Emergency Preparedness and Community Support

Repositories under the Prescription Drug Donation Repository Program, also known as Florida Rx Connects are required to submit forms monthly as follows:

All forms must be signed, dated and submitted by the 5th of each month, even if the repository has no new donations, eligible patients or changes to inspection and storage. If there are no new donations, patients or inspection and storage information, please indicate “No information to report” on the form. Copies of:

  1. Each Patient Application and Dispensing Form

  2. Donation Forms

  3. Destruction of Drugs forms

  4. Transfer Forms

Questions may be sent to: PrescriptionDrugDonationProgram@FLHealth.gov. Please allow at least 24 hours for a response.