REGULATORY REVIEW
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DEA Form 222
By Kay Knox, Manager, Regulatory Affairs, Henry Schein Animal Health®
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IMPORTANT CONTROLLED SUBSTANCE DEA 222 FORM
PROCEDURAL CHANGES
On March 19, 2013, Henry Schein, Inc. (NASDAQ: HSIC), the world’s largest provider of health
care products and services to office-based dental, medical and animal health practitioners,
announced that Butler Schein Animal Health, will be rebranded as Henry Schein Animal
Health. This transition from Butler Schein Animal Health to Henry Schein Animal Health
underscores Henry Schein’s increasing strength in the global animal health market while
preserving the rich heritage of Butler Schein and linking Henry Schein’s United States
operations more closely with its market-leading animal health businesses throughout Europe
and Australia.
As we rebrand our Company, there are important
procedural changes that will affect our customers
who purchase Schedule 2 and 2N controlled
substances using a print copy DEA 222 Form.
„ Effective June, 3, 2013, all submitted DEA 222
forms must reflect our new business name: HENRY
SCHEIN ANIMAL HEALTH
„ The address to send the forms remains the
same: 3820 Twin Creeks Dr, Columbus, OH 43204.
Customers who use the Express 222 system to
electronically place schedule 2 and 2N controlled
substance orders may continue to place orders
as usual.
For your convenience, a sample copy of a DEA 222
form is located at www.henryscheinvet.com. We
suggest posting this copy as an example for proper
completion of the form.
We regret any temporary inconvenience this may
cause our customers. Please be assured we are
working diligently to ensure all customer orders will
be filled and shipped promptly.
SAMPLE DEA FORM 222
Place this sample with your blank DEA Form 222s for quick reference. Use this sample and the
"7-Step Checklist" (below) to ensure your form is correct before mailing.
See Reverse of PURCHASER'S
Copy for Instructions
HENRY SCHEIN ANIMAL HEALTH
TO:
CITY and STATE
DATE
1
2
3
No.
of
Packages
3*
etc.
.
.
.
.
.
.
.
V
2*
MM/DD/YY
OMB APPROVAL
No. 1117-0010
STREET ADDRESS
3820 TWIN CREEKS DRIVE
TO BE FILLED IN BY SUPPLIER
SUPPLIER'S DEA REGISTRATION NO.
TO BE FILLED IN BY PURCHASER
4*
Size of
Package
Name of Item
250 ML
20 ML
5x10ML
100ML
20 ML
50 ML
Bx 10
5x20ml
250 ML
5
Socumb, 6 GR
Hydromorphone Inj 2 MG/ML
Morphine Sulfate PF 1 MG/ML
Sleepaway, 260 MG
Morphine Sulfate, 15 MG/ML
Fentanyl Cit, 50MCG/ML
Opana 1MG/ML
Fentanyl Cit Amp 50MCG/ML
Fatal Plus
Fentanyl Patches *(see below)
LAST LINE
COMPLETED
Date Issued
(MUST BE 10 OR LESS)
DEA
Registration No.
SIGNATURE OF PURCHASER OR
ATTORNEY OR AGENT
National Drug Code
Packages
Shipped
Date
Shipped
Sign Name HERE
5*
(Name and Address of Registrant)
(NOTE: THE NAME AND ADDRESS APPEARING IN THIS
BLOCK MUST BE EXACTLY THE SAME AS THE NAME AND ADDRESS ON THE DEA FORM
223 - CONTROLLED SUBSTANCE REGISTRATION)
Schedules
Registered as a
Sincerely,
1*
COLUMBUS, OH 43204
L
I
N
E
No.
No order form may be issued for Schedules I and II substances unless a
completed application form has been received (21 CFR 1305.04).
Form No.
U.S. OFFICIAL ORDER FORMS - SCHEDULES I & II
SUPPLIER'S COPY 1
* Indicate Fentanyl Patches as 25mcg, 50mcg, 75mcg, or 100mcg
*****7-Step Checklist*****
Kay Knox
Manager, Regulatory Affairs
Henry Schein Animal Health
regulatoryaffairs@henryscheinvet.com
1.
2.
3.
4.
5.
6.
7.
The name of supplier, address, city and state is correct.
The form is dated.
The number of packages, size of package, and strength desired is correct.
The "LAST LINE COMPLETED" block is filled in.
The DEA Registrant or Power of Attorney has signed the form.
The form contains no erasures or alterations.
Remove the purchaser's copy (blue copy) and place in your records.
P.S. Please stay tuned for future communications
from Henry Schein Animal Health (formerly known
as Butler Schein Animal Health).
74 | Henry Schein Animal Health¨
ph: (855) HSAHVET (472-4838) | fx: (888) 329-3861 | www.henryscheinvet.com