Prescription Drug Pedigree 2025

See details

4.8 out of 5

145 votes

The document is a Prescription Drug Pedigree form used by wholesalers to track the history of sales and distributions of prescription (legend) drugs. It includes sections for identifying the drug, its repackaging status, ownership history, and physical distribution details. The form requires information about the manufacturer, wholesaler transactions, recipient signatures, and authentication contacts to ensure compliance with regulations regarding drug pedigree tracing.

Here's how it works

01. Edit your drug pedigree online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Prescription Drug Pedigree with DocHub

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Prescription Drug Pedigree in our editor.
Begin by entering the wholesaler’s name at the top of the form. This identifies who is completing the pedigree.
Fill in the drug details, including the Legend Drug Name, Strength, Dosage Form, and Container Size. If applicable, check the box indicating that this is a repackaged drug.
Provide optional NDC information and complete the Reference Number, Lot Number, Quantity, Unique Serial #, Document Type, and Reference Date related to the sale.
In the Ownership History section, input details about the manufacturer and any wholesalers involved in previous transactions. Ensure to include names, addresses, dates purchased, and signatures where required.
Complete all necessary fields for each transaction listed under Physical Distribution History. Repeat as needed for additional sales.
Finally, sign and date at the bottom of the form to affirm that all information is accurate and complete.

Start using our platform today to streamline your Prescription Drug Pedigree process for free!

See more Prescription Drug Pedigree versions

We've got more versions of the Prescription Drug Pedigree form. Select the right Prescription Drug Pedigree version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2011	4.8 Satisfied (44 Votes)
2006	4.8 Satisfied (145 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a drug pedigree?

A product pedigree describes its design and how it was built and shows that it was built in accordance with the drawings and other documentation defining the product configuration. Evaluating the pedigree of a failed product can help to rule in or rule out hypothesized failure causes.

What is meant by pedigree?

(PEH-dih-gree) A diagram of family history that uses standardized symbols. A pedigree shows relationships between family members and indicates which individuals have certain genetic pathogenic variants, traits, and diseases within a family as well as vital status.

What is a pedigree statement?

Pedigree means a statement or record in a written form or electronic form, approved by the board, that records each wholesale distribution of any given prescription drug (excluding veterinary prescription drugs), which leaves the normal distribution channel.

What is a pedigree in pharma?

A drug pedigree is a statement of origin that identifies each prior sale, purchase, or trade of a drug, including the date of those transactions and the names and addresses of all parties to them.

Is there a $2000 cap on prescription drugs for seniors?

Pedigree documentation is like your dogs birth certificate. It holds critical information about your dogs lineage, helping you understand not only where your dog comes from but also crucial details about their health and genetics.