Government of Ontario: Ministry of Health and Long-Term Care

Ontario Government Pharmaceutical and Medical Supply Service

99 Adesso Drive
Concord ON L4K 3C7

Tel.: (416) 327-0837 Fax: (416) 327-0818

Return Authorization for Resalable Drugs and Medical Supplies

Conditions for “Returns” (OGPMSS will only accept returns and provide credit for resalable drugs or supplies):

Unopened bottles in good condition with no broken seals or other damage; free of external markings.
Complete shelf packs, i.e., order unit.
At least 6 months expiry date.
Products purchased over one year prior to the request for returns, provided that a copy of the original invoice is included with the “Return”.

Complete and fax form to OGPMSS - Customer Service in order to obtain a Return Authorization Number.
Return exact amount as stated/approved on this request.
Clearly mark each package with the Return Authorization Number.
Include this form with the return (1 form for each Return Authorization Number).
Give to OGPMSS driver when next order is delivered.

Client Name

Client no.

Return Authorization No. (for OGPMSS Use Only)

Returned by

Telephone no. () - ext

Date yyyy mm dd

Pick-up address
Street number

Street name

City/town ON Postal code

Name of contact (last name, first name)

Telephone no.
() - ext

Pick-up instructions (i.e. reception)

Complete all sections

Qty/Unit