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Claude Moore Library
School of Nursing
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UVA
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New NDC Request
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New NDC Request
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Medication
Drug name
Dosage Form
Tablet, capsule, syringe, suspension, etc
Medication Strength
mg, g, etc
Medication Volume
Total volume of product
Medication Concentration
mg/mL, g/mL, %, etc
Product NDC
For products without and NDC, please enter the UPC code.
Refrigerated Item
Please check box if this is a refrigerated item. These items should be left in the "Waiting for Pharmacy IT" bin in the refrigerated once ticket is completed.
Comments
Please enter any information that may be helpful.
For Supply Chain Use ONLY
Why is this product being ordered?
N/A
Preferred product (this is a permanent switch)
Short term shortage
Long term shortage
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New NDC Request