Apply for a Waste Medications Collection Waiver

Next steps for Apply for a Waste Medications Collection Waiver

1. Complete a Waiver Application

   Use the applicable form below to

   • Participate in the next National Prescription Drug Take Back Day or hold another one-time collection event, or
   • Establish a permanent collection kiosk at a local police station, or
   • Establish a permanent collection kiosk in a retail or hospital/clinic-based pharmacy.

   Note: You may fill out and save Microsoft Word forms on your computer. PDF versions have to be printed out and completed by hand.

   Open DOC file, 102 KB, for Waiver for a One-Time Collection Event (DOC 102 KB)

   Open PDF file, 50.19 KB, for Waiver for a One-Time Collection Event (PDF 50.19 KB)

   Open DOC file, 105 KB, for Waiver for a Kiosk at a Police Station (DOC 105 KB)

   Open PDF file, 36.97 KB, for Waiver for a Kiosk at a Police Station (PDF 36.97 KB)

   Open DOC file, 101.5 KB, for Waiver for a Kiosk at a Pharmacy (DOC 101.5 KB)

   Open PDF file, 37.64 KB, for Waiver for a Kiosk at a Pharmacy (PDF 37.64 KB)

2. Submit Your Application to MassDEP

   Scan your signed waiver application form and email it as an attachment to: fabien.campbell@state.ma.us