Any location participating in the Medications Return Program and/or the Sharps Collection Program may complete this order form. The following promotional and educational items are available free of charge. Pharmacy Information Pharmacy/Company Name * HPSA ID * Make sure the information below matches the pharmacy's shipping information. Address * City * Province * - Sélectionner -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code * Requester's Information Requester's Name * Requester's Title * Phone Number * Email * Promotional Item Bookmarks - Aucun -100250500 MRP Rack Card - Aucun -100250500 SCP Rack Card - Aucun -100250500