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

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Repository Forms

Division of Emergency Preparedness and Community Support

Repository Enrolled List


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

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.

  • Each Patient Application and Dispensing Form
  • Donation Form(s)
  • Destruction of Drugs form(s)
  • Transfer Form(s)

If you have any questions, contact PrescriptionDrugDonationProgram@FLHealth.gov. Please allow at least 24 hours for a response.

  • Forms