Share your location for a better experience
Please enter your city or town so we can help you find the right care at the right place.
Patient information & request form
Submit this request form and a pharmacist will contact you to complete the process.
What you'll need
Please allow 3 - 5 minutes to complete the request form
Review naloxone instructions
Please reserve a few minutes to learn about how to administer naloxone once you receive it.
Insurance information
Have your prescription insurance coverage details ready (if applicable).
Payment method
Depending on insurance coverage, you'll complete the request by paying for your medication.