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Material transfer form excel

Material transfer form excel 2026

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The document is a DEA Regulated Materials Transfer Form required for the transfer of DEA Schedule III-V materials. It includes fields for supplier and purchaser information, drug details, and signatures. The form is used by Clean Harbors as a reverse distributor and was issued on 10/09/2009.

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Click ‘Get Form’ to open the material transfer form in the editor.
Begin by filling in the 'Name of Supplier' section with the supplier's full name, followed by their contact information including phone and fax numbers.
Enter the supplier's address details: street address, city, state, and zip code.
Specify the 'Date of transfer' and include the Supplier DEA Registration Number for compliance.
In the 'Drug Name' section, list each drug being transferred along with its corresponding schedule and dosage form. Ensure to fill out all relevant fields from 1 to 24 as needed.
Complete the 'Purchaser DEA Registration No.' field and provide your signature along with your name and address.
Finally, ensure that all required signatures are obtained before submitting the form for processing.

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