Verification of Licensure Prior to the Sale or Distribution of 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the prescriber’s name and license number in the designated fields. Ensure accuracy as this information is crucial for verification.
3. Next, indicate whether the prescriber holds a Terminal Distributor of Dangerous Drugs (TDDD) number. If applicable, provide this number in the specified section.
4. In the following section, confirm that you have verified the prescriber’s licensure status through Ohio's online licensing registry. This step is essential for compliance.
5. Finally, review all entered information for completeness and accuracy before submitting your form. This ensures that your request for drug samples or complimentary supplies is processed without delays.

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