Purchasing Requests for Facilities — Vancouver Acute Pharmaceutical Sciences

Vancouver General Hospital Pharmacy

Medication Purchasing Request Form for Facilities

This form is to be used ONLY for medication purchasing requests by facilities (not for general public or patients). Only use this form for non-urgent requests. If the medication is needed within 1 business day or less, please contact VGH Pharmacy Purchasing directly.

A staff member will contact you during our regular business hours to confirm your request.

Name of Facility

Name of Requestor

First Name

Last Name

Phone

(###)

###

####

Date Medication Required By

Note: for urgent requests needed within 1 business day or less, please contact VGH Pharmacy Purchasers directly

YYYY

Name & Strength of Requested Medication

Quantity Requested

Other Details