Pharmacy Name
*
(required)
Pharmacy Email
*
(required)
Pharmacy Address (to receive deliveries)
*
(required)
Suburb
*
(required)
Postcode
*
(required)
PBS Approval Number
*
(required)
Pharmacy Phone
*
(required)
Pharmacy Fax
Name of staff member registering for the program
*
(required)
Position within the pharmacy:
Owner
Pharmacy Manager
Pharmacist
Retail Manager
Currently, due to budget caps, we are unable to allocate a 120L sharps disposal bin to newly registered pharmacies.
Do you wish to register for the PNSP with the understanding that you will not receive a 120L sharps disposal bin?
*
(required)
Yes
I agree to the Terms & Conditions
*
(required)
Yes
Ignore