Submit an annual report for emergency contraception

For use by community pharmacies participating in the Massachusetts Pharmacy Access Program.

Sexual and Reproductive Health Program

The Details of Submit an annual report for emergency contraception

What you need for Submit an annual report for emergency contraception

  • Name of pharmacy/chain
  • Address
  • Fax number
  • If you're a retail pharmacy
    • Pharmacy License (Permit) No. (Pharmacy Board)
  • If you're a hospital/clinic pharmacy
    • Controlled Substance Registration No. (DCP)
  • Information of the authorized pharmacy representative submitting report:
    • Name
    • Title
    • Email
    • Phone number
  • The total number of units of use of EC
    • For the annual period from July 1 to June 30. For example, Plan B® One-Step, Take ActionTM, or ella®

How to submit Submit an annual report for emergency contraception

  1. Download and complete the Emergency Contraception Dispensing Annual Reporting Form (RTF)
  2. Fax to (617) 624-6062, ATTN: MDPH Family Planning Program
  1. Download and complete the Emergency Contraception Dispensing Annual Reporting Form (RTF)
  2. Email (as an attachment) to pharmacy.dph-ec@state.ma.us

Contact for Submit an annual report for emergency contraception

Address
Massachusetts Department of Public Health
250 Washington St., 5th Floor, Boston, MA 02108
Fax
(617) 624-6062

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